Parity FAQ for Addiction and Mental Health Consumers

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Massachusetts 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.

 

Consumer Advocates


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 Massachusetts.

Health Policy Commission
Office of Patient Protection
50 Milk Street, 8th Floor
Boston, MA 02109
(800) 436-7757
Fax: (617) 624-5046

Health Law Advocates
One Federal Street Boston, MA 02110
617-338-5241
888-211-6168
www.healthlawadvocates.org

Greater Boston Legal Services
197 Friend Street
Boston, MA 02114
617-371-1234
800-323-3205
617-371-1228(TDD)

Cambridge/Somerville
60 Gore Street, Suite 203
Cambridge, MA 02141
617-603-2700
617-494-1757 (TDD)

Mental Health Legal Advisors
24 School Street, Suite 804
Boston, MA 02108
617-338-2345
800-342-9092 (toll free MA only)
Fax: 617-338-2347
General email: MHLAC@mhlac.org
Intake email: Intake@mhlac.org

Health Plan Contacts


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 Massachusetts Health Plans:

BlueCross BlueShield of Massachusetts

Call Member services at the number on the member ID card

Information regarding Appeal and Grievance Program found here

Fallon Community Health Plan

Customer Service: (800) 868-5200

HOW TO FILE AN APPEAL ABOUT COVERED MEDICARE MEDICAL BENEFITS

To file a grievance:
Call (800) 333-2535, or
Send a letter to:
Fallon Health
Member Appeals and Grievances
10 Chestnut Street
Worcester, MA 01608; or
Send email to grievance@GCHP.org or fax: (508) 755-7393

Harvard Pilgrim Health Care

Call Member Service
Grievance Filing:
Call: (888) 609-0692

Harvard Pilgrim Health Care
Medicare Advantage Stride
Appeals & Grievances
P.O. Box 690345
Quincy, MA 02269

Health New England

Contact Member Services: 800-310-2835

Neighborhood Health Plan

Customer Service for Prime Members: 866-414-5533

MassHealth Members call: 800-462-5449

Tufts Health Plan

Call Customer Service: (888) 257-1985
Mail:
Tufts Health Plan
Attn: Grievance Coordinator
PO Box 9193
Watertown, MA 02471-9194

 

State Regulators


 

Insurance Commissioner

Office of Consumer Affairs and Business Regulation, Massachusetts Division of Insurance
Commissioner
1000 Washington Street
Boston, MA 02118
Phone: (617) 521-7794
Fax: (617) 753-6830
http://www.mass.gov/ocabr/government/oca-agencies/doi-lp/

Utilization Management Appeals

Bureau of Managed Care
Office of Patient Protection
Director
Health Policy Commission
50 Milk Street, 8th Floor
Boston, MA 02109
Phone: (617) 979-1413
www.mass.gov/hpc/opp

External Review Appeals

Bureau of Managed Care
Office of Patient Protection
Director
Health Policy Commission
50 Milk Street, 8th Floor
Boston, MA 02109
Phone: (617) 979-1413
www.mass.gov/hpc/opp

Parity Appeals

Bureau of Managed Care
Director
Division of Insurance
1000 Washington Street
Boston, MA 02118
Phone: (617) 521-7347
Fax: (617) 521-7750
www.state.ma.us/doi

Massachusetts Attorney General’s Office
(The Massachusetts Attorney General’s Office has a Health Care Division that handles mental health parity complaints involving private, fully-insured health plans only.)
One Ashburton Place
Boston, MA 02108
If your complaint is urgent or if you seek an accommodation due to a disability, call the Health Care Helpline at 1-888-830-6277 or 617-727-4765 TTY.
E-Complaints: http://www.mass.gov/ago/bureaus/hcfc/the-health-care-division/filing-a-health-care-complaint.html

Mass Health
800-841-2900

Additional Massachusetts Insurance Administration Contacts, click here.

 

Federal Regulators


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

 

Veteran and Military Resources


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.

Questions


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