Your health insurance has to cover mental health treatment the same way it covers physical health problems – that’s what mental health parity laws require. But many people don’t realize they have these rights, or they don’t know what to do when their insurance company tries to limit mental health benefits in ways they wouldn’t limit coverage for other medical conditions.

What Parity Actually Means

Mental health parity means your insurance can’t have stricter limits on mental health care than on medical care. If your plan covers unlimited doctor visits for diabetes management, it can’t limit you to just 10 therapy sessions per year. If there’s no copay for preventive medical care, there shouldn’t be a copay for preventive mental health services either.

The law covers several areas where insurance companies used to discriminate against mental health treatment:

• Copays and deductibles must be the same for mental health as medical care

• Visit limits can’t be more restrictive for therapy than for other ongoing treatments

• Prior authorization requirements can’t be harder to meet for mental health services

• Network adequacy means enough mental health providers must be available in your area

• Coverage decisions can’t be based on different criteria for mental health versus medical conditions

This applies to most employer-sponsored insurance plans and individual marketplace plans. The rules are part of federal law, so they apply nationwide, though enforcement can vary.

When Your Insurance Isn’t Following the Rules

You might be experiencing parity violations if your insurance requires prior authorization for therapy but not for physical therapy, limits mental health visits while allowing unlimited specialist visits for chronic conditions, or has higher copays for psychiatrist visits than for other specialist appointments.

Network adequacy violations are common too. If you can’t find an in-network therapist accepting new patients within a reasonable distance, but you can easily find other specialists, your plan might not be meeting parity requirements.

Some insurance companies still try to deny mental health claims using criteria they wouldn’t apply to medical claims. They might require you to “fail” at less expensive treatments before approving more intensive therapy, even though they wouldn’t make someone with heart disease try cheaper treatments first.

Fighting Back When Coverage Gets Denied

Start by documenting everything. Keep records of denied claims, prior authorization requests, and any communication with your insurance company about mental health benefits. Compare how they handle similar requests for medical care.

When you file an appeal, specifically mention mental health parity laws. Many insurance companies will reconsider denials when parity violations are pointed out directly. Your appeal letter should compare the denied mental health benefit to similar medical benefits that would be covered.

Your state’s insurance commissioner office can help with parity complaints. Most states have processes for investigating whether insurance companies are violating parity laws. The Department of Labor also enforces parity laws for employer-sponsored plans.

If your employer offers an Employee Assistance Program (EAP), they often have benefits advocates who can help you navigate insurance appeals and parity issues. Some employee benefits departments are also knowledgeable about parity requirements.

Making Parity Work for Your Mental Health

Understanding your parity rights helps you advocate for appropriate mental health coverage. Before starting treatment, call your insurance company and ask about mental health benefits. Specifically ask if there are visit limits, prior authorization requirements, or different copays for mental health services.

When choosing a therapist or psychiatrist, verify that your insurance company’s provider directory is accurate and up-to-date. If you can’t find available in-network mental health providers, document your search efforts and contact your insurance company about network adequacy.

Keep detailed records of all mental health-related insurance interactions. This documentation becomes valuable if you need to file appeals or complaints about parity violations.

Mental health parity laws exist because insurance companies historically treated mental health as less important than physical health. These protections ensure you can get appropriate mental health care without facing discriminatory barriers that wouldn’t exist for other medical conditions.