Parity FAQ for Addiction and Mental Health Consumers

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New York 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 New York.

Community Service Society
Community Health Advocates
888-614-5400
http://www.cssny.org/programs/entry/community-health-advocates

New York State Department of Financial Services (Insurance Department)
Consumer Hotline: 800-342-3736
Complaint Form
Health Insurance Information and External Appeal Form: http://www.dfs.ny.gov/consumer/chealth.htm

Office of the Attorney General
Health Care Bureau
Consumer Helpline: 800*428-971
Complaint Form

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 New York Health Plans:

EmblemHealth

Call Customer Service at 877-842-3625

How to file information can be found here.

Excellus BlueCross BlueShield

Call Customer Service: 1(877) 883-9577
Excellus BlueCross BlueShield
Customer Advocacy Unit
PO Box 4717
Syracuse, New York 13221
Information: Grievance & Appeal

Fidelis Care (Medicare Advantage and Dual Advantage)

Call: 1(800) 247-1447

Fidelis Care
Member Services Department
95-25 Queens Boulevard
Rego Park, New York 11374
Fax: 1(877)533-2402

HealthNow

Customer Services: 1-800-856-0480 or call the number listed on the member ID card.

MVP Health Care

Customer Care Center: 1(888) 687-6277

MVP Health Care
Attn: Member Appeals Department
625 State Street
Schenectady, New York 12305

Oscar

To file a grievance use this form
Mail to:
Oscar Insurance
Attention Grievances
PO Box 52146
Phoenix, AZ 85072

Email: help@hioscar.com
Attn: Grievances

 

State Regulators


 

Insurance Commissioner

New York State Department of Health
Supertintendent
Corning Tower, Empire State Plaza
Albany, NY 12237
Phone: (518) 474-2011
Fax: (518) 474-5450
https://www.health.ny.gov/commissioner/

Utilization Management Appeals

New York State Department of Health, Bureau of Managed Care Certification and Surveillance
Project Manager, Utilization Review
Corning Tower, Room 1911
Albany, NY 12237
Phone: (518) 474-4156
Fax: (518) 473-3583
http://www.dfs.ny.gov

External Review Appeals

New York State Department of Financial Services
P.O. Box 7209
Albany, NY 12224
Phone: (800) 400-8882
Fax: (888) 990-3991
externalappealquestions@dfs.ny.gov
http://www.dfs.ny.gov/insurance/extapp/extappqa.htm

Parity Appeals

New York State Department of Health, Bureau of Managed Care Certification and Surveillance
Project Manager, Utilization Review
Corning Tower, Room 1911
Albany, NY 12237
Phone: (518) 474-4156
Fax: (518) 473-3583

Additional New York 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