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New Jersey Parity Resources

Depending on whether you are filing a complaint or appeal, the contact information below should be able to help you if you have any questions.

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 New Jersey.

Department of Banking and Insurance
Office of Insurance Claims Ombudsman

Consumer Protection Services
PO Box 329
Trenton, NJ 08625-0329

NJ FamilyCare
Hotline for assistance: 609-588-2655
http://www.state.nj.us/humanservices/dmahs/home/index.html

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 New Jersey Health Plans:

Aetna
Contact Member Services at the phone number on the member ID card
Complaint and Appeal form found here
Mail written request to:
Aetna
PO Box 14463
Lexington, KY 40512

AmeriHealth-New Jersey
Customer service: (888) 968-7241

CIGNA
Call Members Services at the number listed on the member ID card

Health Republic Insurance of New Jersey
Call: (888) 990-5706

Horizon Blue Cross Blue Shield of New Jersey
Contact member services File an Appeal/Dispute Form, click here
Request for Redetermination of Medicare Prescription Drug Denial Click here for form

Mail to:
Appeals Department
MC 109 PO Box 52000
Phoenix, AZ 85072-2000
Fax: 1-855-633-7376

Oscar Garden State
Call: (844) 672-2766
To file a grievance use this form
Mail to:
Oscar Insurance
Attention Grievances
PO Box 278
New York, NY 10013

Oxford Health (United Healthcare)
Call the Customer Service number found on the member ID card.

Insurance Commissioner
Department of Banking and Insurance, Office of Managed Care
Chief
P.O. Box 325
Trenton, NJ 08625-0325
Phone: (609) 777-9470
Fax: (609) 633-0807

Utilization Management Appeals
Department of Banking and Insurance, Office of Managed Care
Chief
P.O. Box 325
Trenton, NJ 08625-0325
Phone: (609) 777-9470
Fax: (609) 633-0807

External Review Appeals
Department of Banking and Insurance, Office of Managed Care
Chief
P.O. Box 325
Trenton, NJ 08625-0325
Phone: (609) 777-9470
Fax: (609) 633-0807

Parity Appeals
Department of Banking and Insurance, Office of Managed Care
Chief
P.O. Box 325
Trenton, NJ 08625-0325
Phone: (609) 777-9470
Fax: (609) 633-0807

Additional New Jersey 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

More Parity Information:

Please note: Parity Registry does not automate the appeals process. The information you provide may alert policymakers to possible health plan violations of the law, thereby helping to shape public policy and influence legislation.

You must take follow-up action with your health plan or regulatory agency.