Georgia Parity Resources

For general information about filing a parity appeal for mental health or addictions services, you cannot go wrong with contacting one of the consumer advocates below. Each has years of experience helping consumers in the state of Georgia. Attorney General, Consumer Protection Unit For Consumer Services involving a complaint, click here. Georgia Department of Insurance Consumer Services Division: 800-656-2298

When filing an appeal for the first time, you should contact your health plan’s customer service support line or check out their information online. If you choose to appeal an adverse benefit determination concerning your mental health or substance use treatment or benefits, please keep in mind that the timeframe to do so varies by state, plan type, and other factors. Contact your state’s department of insurance for additional information. Here is some contact information for Georgia Health Plans:

Aetna

Contact Member Service at the number listed on the member ID card. For information concerning complaints, grievances or appeals click here.

Blue Cross Blue Shield of Georgia

Call the customer care number found on the member ID card.

Coventry

Contact customer Service at the number found on your member ID card or Call: 800-255-0056

Humana

Click here for Grievance/Appeal Request Form Mail to: Humana Inc. Grievance and Appeal Department PO Box 14546 Lexington, KY 40512-4546 Medicare Members mail to: Humana Inc. Grievance and Appeal Department PO Box 14165 Lexington, KY 40512-4165

Kaiser Permanente

Call Customer Service (888)865-5813 or (404)261-2825

United Healthcare

Call Customer Service By mail: United Healthcare PO Box 740800 Atlanta, GA 30374-0800  

Insurance Commissioner

Office of Insurance and Safety Fire Commissioner Commissioner 2 Martin Luther King, Jr. Drive, West Tower, Suite 6-604 Atlanta, GA 30334 Phone: (404) 657-1705 Fax: (770) 408-5939

Utilization Management Appeals

Office of Insurance and Safety Fire Commissioner, Insurance Product Review Support Services Specialist 2 Martin Luther King, Jr. Drive, West Tower, Suite 6-604 Atlanta, GA 30334 Phone: (404) 657-1705 Fax: (770) 408-5939

External Review Appeals

Office of Insurance and Safety Fire Commissioner with Support from the Georgia Department of Community Help Senior Health Systems Analyst 2 Peachtree Street NW, 5th Floor Atlanta, GA 30303 Phone: (404) 463-1101

Parity Appeals

Office of Insurance and Safety Fire Commissioner Support Services Specialist 2 Martin Luther King, Jr. Drive, West Tower, Suite 6-604 Atlanta, GA 30334 Phone: (404) 657-1705 Fax: (770) 408-5939   Additional Georgia Insurance Administration Contacts, click here.  

The federal government also can be a helpful resource if you are enrolled in a self-funded plan, Medicare, Medicaid or another type of insurance that is overseen at least in part by a federal agency.

For definitions and filing information refer to the Parity Resource Guide

U.S. Department of Health and Human Service’s website on the Affordable Care Act health reform law

U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA)

(SAMHSA) Implementation Mental Health Parity Addiction Equity Act

U.S. Centers for Medicare and Medicaid Services (CMS)

U.S. Department of Labor, Employee Benefits, Security Administration (EBSA) or toll-free hotline: 1.866.444.EBSA (3272)

For the U.S. Department of Health and Human Services & Centers for Medicare and Medicaid Services list of exempt state and local plans, please email NonFed@cms.hhs.gov. You may ask them if any particular state and local plan has opted out of MHPAEA.

Information on requirements of employer-based insurance coverage and self-insured health plans.
EBSA has benefit advisors who are available to answer questions and provide assistance in obtaining your benefits.

Consumer Guide to Disclosure Rights: Making the Most of Your Mental Health and Substance Use Disorder Benefits

Veterans and military personnel can use these resources to get help or more information with their medical or behavioral health complaints.

Health Net Federal Services

A grievance is a written complaint or concern about a medical provider.
Click here for specific information regarding who, what and how to file.

TRICARE

View the recently released Tricare Mental Health Fact Sheet.

The appeal process is different based on the benefit issue. Depending on your issue, you can file a:

• Factual appeal
  • This is if you were denied payment for services or supplies you received, or if payment was stopped for services or supplies previously authorized.
• Medical necessity appeal
  • This is if prior authorization for care or services was denied because it was not deemed medically necessary. Medically necessary means it must be appropriate, reasonable, and adequate for your condition.
• Pharmacy appeal
  • This is if you don’t agree with a decision made about your pharmacy benefit. For example, Express Scripts denies your pharmacy claim.
• Medicare-TRICARE appeal
  • This is if you’re eligible for both TRICARE and Medicare, and Medicare denies your services or supplies.

If your care is denied, you should receive a letter with details about how to file your appeal.

Veterans Health Administration

Complaints are initially handled through the Patient Advocate.
Patient Advocate can be contacted at your local VA Medical Center.

If you have any additional questions about parity compliance, please contact info@paritytrack.org