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TDCI Joins the Department of Mental Health & Substance Abuse Services to Remind Consumers About Mental Health Parity Rules

Tennessee Consumers Can File Complaints When Denied Mental Health Coverage
Thursday, May 20, 2021 | 09:37am

NASHVILLE – As part of commemorating May as Mental Health Month, the Tennessee Department of Commerce (TDCI) joins the Tennessee Department of Mental Health & Substance Abuse Services (TDMHSAS) to remind consumers that mental health benefits should be treated equally by insurance providers.

Under the Mental Health Parity and Addiction Equity Act of 2008, if a consumer’s health plan covers mental health and substance use services, the plan must match its coverage with the plan’s physical health coverage. Large group health plans cannot impose annual or lifetime dollar limits on mental health benefits that are less favorable than any such limits imposed on medical/ surgical benefits. However, if a plan is very limited then mental health coverage will be similarly limited even in a state with a strong parity law or in a plan that is subject to federal parity.

“Mental health care is a vital component of health care,” said TDCI Commissioner Carter Lawrence. “Caring for emotional, psychological and mental well-being is just as important as care for a physical injury.”

Mental health was a major focus of Americans during the pandemic as between 30 and 40 percent of Americans reported symptoms of anxiety and depression and in Tennessee the numbers were similar. The rate has gone down slightly in the last few months, but it’s still at 35 percent. Compare that to 20 percent in a typical year, and you’ll quickly see the emotional impact of the past year. The largest barrier to improved mental health is often the stigma of taking that first step and seeking help.

“Parity is an essential element of overcoming the stigma around behavioral health issues,” said TDMHSAS Commissioner Marie Williams, LCSW. “As more people learn that their mental health and addiction issues will be treated the same as their physical health needs, they will be more likely to ask for the help they need. We’re grateful to our partners at TDCI for shining a spotlight on this important issue.”

When it comes to mental health and substance abuse insurance coverage, consumers should remember:

  • If you need treatment for substance use or mental health, your health insurance may cover some of the costs. This means the copay, number of days for staying in a hospital or treatment facility, prior authorization, prescription drug tiers and maximum benefit limits must be the same for both mental health and physical health services. For example, if your copay is $30 for physical health services, it must be $30 for mental health services. If your plan covers 40 physical therapy visits, your plan must cover 40 behavioral health visits.
  • Mental health and substance use treatment include therapy, in-patient and out-patient treatment, medication management for detoxing and mental health disorders such as depression, schizophrenia, bipolar disorder and psychotic disorder, Applied Behavioral Analysis for the treatment of Autism Spectrum Disorder and more.
  • Your health plan must provide a directory of in-network professionals and facilities that are close to you. The law does not provide payments if the provider does not accept insurance. If the provider does not accept insurance then the patient would need to find a provider who does take insurance or pay for the services out of pocket.
  • Contact your health insurance company to see if your plan includes mental health and substance use services and get more information.
  • Denied a claim or experiencing delays in having your claim accepted, contact TDCI Consumer Insurance Services at 615-741-2218 or 1-800-342-4029. You can file a complaint by visiting tn.gov/insurance and selecting “File a Complaint.” Some health plans are federally regulated by the U.S. Department of Labor. To file a complaint for a federally regulated plan, visit http://www.askebsa.dol.govor call 1-866-444-3272.

More information about Mental Health Parity can be found in a new blog post from TDCI Insurance Division Education and Outreach Specialist Jennifer Ramcharan.

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About the Tennessee Department of Commerce & Insurance: Fostering fair marketplaces, public safety, and consumer education that promote the success of individuals and businesses while serving as innovative leaders. Our divisions include the State Fire Marshal’s Office, Insurance, Securities, Regulatory Boards, Tennessee Law Enforcement Training Academy, Tennessee Emergency Communications Board and TennCare Oversight.