Your Rights under the Massachusetts Mental Health Parity Laws and the Federal Mental Health Parity and Addiction Equity Act (MHPAEA)
Posted on December 17, 2013
You may have rights under state and federal mental health parity laws. Both laws say that health plans must cover treatment for mental health and substance use disorders in the same way that they cover treatment for medical conditions. This means that copays, coinsurance and deductibles, for mental health conditions must be the same as those for medical conditions. Also, mental health office visit copayments must not be greater than primary care visits. The methods we use to review coverage for mental health or substance use disorder benefits are comparable to those we use to review medical benefits. Clinical standards may permit a difference in how benefits are reviewed.
If you think HNE is not covering treatment for mental health and substance use disorders in the same way that we cover treatment for medical conditions, you may file a complaint with the Division of Insurance (DOI) Consumer Services Section.
You may file a written complaint by using the DOI’s Insurance Complaint Form. You may request a copy of the form by phone or by mail. You also can find the form on the DOI’s webpage at:
http://www.mass.gov/ocabr/consumer/insurance/file-a-complaint/filing-a-complaint.html
You may also submit a complaint by telephone by calling 877.563.4467 or 617.521.7794.
If you submit a verbal complaint, you must follow up in writing. You must include the following information on the Insurance Complaint Form:
1. Your name and address
2. The nature of your complaint
3. Your signature authorizing the release of any information to help the DOI with its review of the complaint.
A parity complaint is not the same as an appeal under your Plan. You may still need to file an appeal with HNE. Filing an appeal with HNE may be necessary to protect your right to continued coverage of treatment while you wait for an appeal decision. Follow the appeal procedures outlined in your Explanation of Coverage for more information about filing an appeal.
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