While the premise of the Mental Health Parity and Addiction Equity Act law was simple - to provide equity between the treatment of mental health and addictive disorders and medical/surgical conditions - the regulations implementing the law are quite complicated.
As a result, it can be hard for patients, family members, providers, advocates and others to understand what protections the law affords and what to do if the law is not being complied with.
This site is intended to help clarify the federal parity law. However, this information does not constitute legal advice or substitute for legal counsel.
Frequently Asked Questions
The term parity means “equal to." The parity law is fundamentally grounded in ensuring equal access to treatment services under both the behavioral health and medical benefits offered by a health plan. Thus, the parity law requires that a health plan’s policies and practices to cover behavioral health services cannot be more restrictive than policies and practices for medical or surgical services. The comparisons between behavioral and medical/surgical benefits are made according to the same classes of benefits, namely:
• Inpatient to inpatient
• Outpatient to outpatient
• In-network to in-network
• Out-of-network to out-of-network
• Emergency care to emergency care
• Prescription drugs to prescription drugs
A parity violation can take many forms. Some policies and practices covered under the parity law are easily measured by a dollar amount or a number; for example, “financial requirements” such as co-payments or deductibles and “quantitative limits” such as the number of outpatient visits allowed each year. Under the parity law, financial requirements and quantitative limits cannot be more restrictive for behavioral health services than for medical services in the same class of benefits.
More information about common parity compliance problems is available on our website and in Part IV of the Parity Resource Guide.
It is critical to understand the insurance policy and benefits. Often, a summary plan description (SPD) and Benefit Booklet are made available to the insured. This information should be offered through the insurance company’s website, an online Exchange or in-house through an employer’s HR department. The insurance broker, plan representative or human resources personnel will know where to find it if the insured individual cannot locate it.
MHPAEA and some state laws allow insured individuals or their providers to challenge a coverage determination if the plan does not cover the same level or scope of services for mental health/substance use disorders as the plan covers for medical/surgical conditions. A parity appeal of denied or limited services may be based upon the insurer’s determination that the behavioral services requested are not medically necessary or are not a covered service under the benefit plan.
The Parity Resource Guide has step-by-step information that can help you file an appeal.