The Maryland Parity Project has two main goals:
- Educating consumers and providers of their rights under the parity law
- Offering case assistance to those whose rights may have been violated
With different state and federal rules governing mental health coverage, understanding the system is complex for both individuals and providers. Our action-oriented Parity Toolkit is designed to help consumers and providers understand the law and take action to enforce their rights.
In addition, project staff provides case assistance to consumers, providers and families who feel they are not receiving the benefits to which they are entitled. We are here to answer questions, evaluate complaints, walk consumers and providers through the process of appealing an insurer’s decision and if appropriate, assist in filing a complaint with the proper government authority.
The Maryland Parity Project would like to acknowledge the generous funding from the following foundations:
Print This Post
- The Fund For Change
- The Morton K. and Jane Blaustein Foundation
- The Zanvyl and Isabelle Krieger Fund
- The Leonard and Helen R. Stulman Charitable Foundation
- The Janssen Foundation
- The Lilly Foundation
- Ensuring that you ask the right questions and talk to the right people
- Walking you through the appeal process- even filing appeals for you
- Evaluating your potential claim and doing the necessary research
If you or your clients are not receiving proper treatment or reimbursement, please contact us
Print This Post
What is the Federal Mental Health Parity Law?
The 2008 Wellstone and Domenici Mental Health Parity and Addiction Equity Act (The Parity Law) aims to create equality between insurance coverage for medical/surgical treatment and mental health/substance abuse treatment. The Parity Law requires health insurers to ensure that financial requirements (deductibles, co-pays, etc.) and treatment limitations (visit limitations, review procedures) for mental health and substance abuse treatment are no more restrictive than requirements or limitations that are applied to medical/surgical benefits. Read more
Who is affected?
The Parity Law applies to individuals who:
- receive insurance through an employer with more than 50 employees
- receive insurance through a local, state or federal government employer
- are covered by Medicaid
Who is not affected?
Only those individuals who are in a grandfathered (pre 2012) group health insurance plan and Medicare beneficiaries are not covered by this law. Medicare is specifically exempted from the federal parity law.
Does The Parity Law require my insurer to offer mental health and substance abuse benefits?
No, The Parity Law does NOT require plans to offer these benefits. The parity requirements apply only to those plans that are currently offering mental health and/or substance abuse benefits (often grouped together under behavioral health).
Will The Parity Law require my insurer to cover all mental health and substance abuse diagnoses and treatments?
No, The Parity Law does not address diagnoses. Plans are allowed to decide which diagnoses will be covered in accordance with applicable state law. Some states require that certain diagnosis be covered. Maryland does not require that any specific mental health diagnoses be covered by insurance plans.
The Parity Law does not address specific treatments and allows for plans to make care management decisions on the basis of medical necessity and recognized standards of care. However the criteria and process used to determine medical necessity of a treatment must be comparable and no more stringent than for medical and surgical care.
What are some of my new rights?
- Right to an appeal of your insurer’s decision
- Right to a written reason of denial of coverage
- If plan provides mental health/addiction coverage in any of the six benefits categories below, it must provide coverage in all.In-network, inpatient
- Mental health and substance abuse treatment coverage may be no more restrictive than medical/surgical coverage. This includes but isn’t limited to:Visit limitations
Pre-authorization or concurrent authorization requirements
Do I still have to get prior authorization for treatment?
Prior authorization requirements are considered treatment limitations. Plans are allowed to implement them, but they must be comparable and no more stringently applied to mental health and substance use treatment. For example, a plan may not require prior authorization for outpatient mental health if there is not a requirement for prior authorization on outpatient medical or surgical benefits.
Can my insurer require that I use a generic medication?
Generic medication requirements, fail first requirements, and preferred drug lists are considered treatment limitations. Plans are allowed to implement them but they must be comparable and no more stringently applied to mental health and substance abuse treatment. A common prescription drug restriction for many plans is to require that generic medications be used before a more expensive medicine can be prescribed. This is allowable under The Parity Law only if the generic requirement applied to both behavioral health medications and somatic medications.
What should I do if I feel my rights have been violated?
Talk to your provider. He or she can help you file an appeal with your insurance company. After exhausting the internal appeals process, you may file a grievance with the Maryland Insurance Administration and/or the US Department of Labor. Read more
Or for help at any point in the process, Contact Us
Print This Post