Mental Health Claims

Various protections have been passed in both federal legislation and state legislation to assure that mental health and substance abuse treatment is protected as an essential benefit. Mental health treatment must be insured equally as to physical health treatment and provide equality or parity between the two. Federal legislation does not by itself require health insurance plans to actually cover mental health benefits but if they are covered, it must be to the equal level of medical and surgical benefits or physical health treatment. Under the Affordable Care Act, private insurance and state-subsidized Medicaid plans must offer mental health service and substance abuse treatment as an essential benefit meaning that it must be offered as a guaranteed benefit by the insurers. There are some uncertainties with regard to the financial requirements in co-pays, coinsurance, and deductibles and whether exclusions for residential treatment are valid. If you’ve had payment for mental health or substance abuse denied please call so we can discuss potential representation.