I’ve been denied medical coverage. How can I file a complaint?

Filing a Complaint Against an Insurance company

• National Association of Insurance Commissioners can connect individuals with state insurance boards for general information regarding insurance laws and filing a complaint against an insurance company for delay in coverage/reimbursement. Use their interactive map web feature to locate state-specific contact information. 

Investigating Medical Parity

The Mental Health Parity and Addiction Equity Act of 2008 requires insurance companies to apply the same standards of coverage for mental health and substance use disorder treatment as they would for the treatment of physical health conditions. For example, the copays and visit limits you have for behavioral health treatment should be comparable to those you have for physical health treatment. If you have been denied medical coverage, you may wish to investigate whether the rejected claim is a violation of parity law. The following resources may be of assistance: 

• The Kennedy Forum provides state-specific information on filing a complaint or appeal for denial of mental health services. The website offers a Health Insurance Appeals Guide and step-by-step support with appealing a parity related decision. 
• ParityTrack helps people understand their rights under the Federal Parity Law and state parity laws. Their Know Your Rights – Common Violations webpage illustrates examples of parity law violations e.g., “My insurance plan refuses to pay for residential behavioral health treatment my doctor says I need.” 
• The Substance Abuse and Mental Health Services Administration (SAMHSA) offers a Know Your Rights: Parity for Mental Health and Substance Use Disorder benefits brochure. The brochure provides information on Parity Law (financial requirements and treatment rules) and one’s rights relating to mental health and substance use disorder benefits. You can contact SAMHSA at (866) 444-3272. 

If you are having trouble applying for federal benefits or getting assistance from a federal agency, you can reach out to your members of Congress for help. More information about how to do that can be found here.

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