Health Law Advocates, Inc.
30 Winter Street, Suite 1004
Boston, MA 02108
Mental health and substance abuse should be treated like any other medical condition when it comes to insurance coverage for treatment. That is the principle behind the state and federal mental health parity laws.
Adults and children who need mental health treatment or substance abuse treatment should have access to the care they need. Both Massachusetts law and federal law require health plans to cover diagnosis and treatment of these conditions at equal levels to coverage for medical and surgical services. The federal Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) prevents health plans from placing higher costs or stricter treatment limitations on consumers who need mental health and substance abuse services. Under the Massachusetts Mental Health Parity Law, insurers may not establish dollar or service amount limits that are more restrictive for biologically-based mental health conditions than for other types of medical conditions and requires a minimum level of coverage for non-biologically based conditions.
Yet despite these protections, some health plans continue to improperly discourage mental health and substance abuse treatment. Patients and health care providers report that denials of coverage are commonplace. Unduly burdensome health plan approval procedures may deter treatment. Patients are often forced to settle for less appropriate treatment or appeal denials of coverage for care within their health plan or to the Massachusetts Office of Patient Protection (OPP). OPP reports that in each year it reported statistics (2002-2010), the single largest category of appeals were filed when health insurance companies denied coverage for mental health or substance abuse care. Between 37% and 58% of the eligible behavioral health appeals last year were resolved wholly or partially in favor of the consumer in each year of the OPP's statistics.
For these reasons, Health Law Advocates is working to make sure that the mental health parity laws are implemented correctly. We represent individuals who need help getting access to mental health or substance abuse treatment, or who need help paying for care. Individuals who need assistance, or providers with patients who need assistance, are encouraged to contact Health Law Advocates for help. We represent clients statewide, and are particularly seeking to assist children residing in Greater Boston.
Health Law Advocates is also advocating to make sure that all Massachusetts residents have access to mental health and substance abuse care, not just consumers who are represented by a lawyer. HLA has been instrumental in working with agency leaders at the Executive Office of Health and Human Services, the Department of Mental Health, the Division of Insurance and the Division of Medicaid to enhance enforcement of the state and federal parity laws in Massachusetts.
Final regulations for implementing the federal mental health parity law of 2008
U.S. Department of Labor Fact Sheet on mental health parity
U.S. Department of Labor Federal Parity Law Frequently Asked Questions (FAQs)
Massachusetts Mental Health Parity laws:
The Mental Health Parity Project is funded by generous grants from