How does one navigate complex common scenarios that may affect their mental health and substance use disorder benefits?

The parity law, also known as the Mental Health Parity and Addiction Equity Act, and other laws require transparency and disclosure of information. The act dictates that third party payers may not treat psychiatric disorders including substance use disorders any differently than they would treat other emdical conditions such as diabetes or hypertension. For example, insurance company may not impose limitations to the number of sessions with a psychiatrist they cover, and may not require stricter coverage requirements for treatments of opioid use disorder than of diabetes. Patients and clinicians often find it difficult to navigate the complex network of public and private sector systems.

Common issues typically relate to understanding the benefits available through one’s healthcare plan. Specifically, what mental health and substance use disorder treatments are covered, how is medical necessity determined, are there any exclusions or limits to covered treatments, understanding in-network and out-of network benefits, co-pays, deductibles and navigating prior authorizations and claim denials to name a few. Local and national resources are available to support patients and their healthcare providers.

Access “Consumer Guide To Disclosure Rights: Making The Most Of Your Mental Health and Substance Use Disorder Benefits” at: https://store.samhsa.gov/product/Consumer-Guide-To-Disclosure-Rights-Making-The-Most-Of-Your-Mental-Health-and-Substance-Use-Disorder-Benefits/SMA16-4992

More Information can be found here:
https://store.samhsa.gov/product/Approaches-in-Implementing-the-Mental-Health-Parity-and-Addiction-Equity-Act-Best-Practices-from-the-States/SMA16-4983

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