What are common examples of parity violations?

The Mental Health Parity and Addiction Equity Act of 2008 intended to address the disparities in how insurance providers dealt with psychiatric illnesses including substance use disorders compared to non-psychiatric disorders. Parity means that financial requirements, such as copayments, and treatment limits, such as how many visits the insurance provider will pay for, must be comparable for physical health and psychiatric including substance use disorder (SUD) treatment services. Parity also applies to rules related to how psychiatric including substance use disorder (SUD) treatment is accessed and under what conditions treatment is covered (such as whether patients need permission from their insurance plan before starting treatment). These include Copayments, Deductibles, Yearly visit limits, Need for prior authorization and Proof of medical necessity. The act dictates that third party payers may not treat psychiatric disorders including substance use disorders any differently than they would treat other medical 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. 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

Access “Know Your Rights: Parity for Mental Health and Substance Use Disorder Benefits” at: https://pcssnow.org/resource/know-rights-parity-mental-health-substance-use-disorder-benefits/

 

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