Many adults in America with a mental illness do not receive the medical treatment they need. Some of the major barriers to treatment are the cost of treatment and insurance denials. If your health insurance company recently denied a mental health claim, it is important that you know you have options. A Los Angeles mental health claims denial lawyer can help you get coverage for the treatment you need. A dedicated insurance denials lawyer understands the system and can use their knowledge to help you.
$3 Million Case Result Dealing with Eating Disorder & Mental Health Coverage
The Mental Health Parity Act
Mental health parity means the same coverage for mental health care as other types of health care. Under California and federal laws, including California Health & Safety Code § 1374.72, health insurance companies cannot legally limit mental health care more than they limit physical health care. This applies to both diagnosis and treatment as well as outpatient and inpatient hospital services and prescription drug coverage. For instance, an insurance carrier cannot place a cap on mental health visits per year if they do not place the same cap on physical health care visits.
Under California law, the following conditions must be treated under health insurance plans:
- Schizophrenia
- Bipolar Disorder (manic-depression)
- Major depressive disorders
- Obsessive Compulsive Disorders
- Pervasive developmental disorders
- Anorexia nervosa
- Bulimia nervosa
- Panic Disorders
- Substance Abuse
When a health insurance carrier denies a claim for treatment of any one of these conditions, the policyholder has options. A Los Angeles mental health claims denial lawyer can work to get them the coverage they need.
2020 Update
California’s legislature passed Mental Health Parity Senate Bill 855 and Governor Newsom signed this bill into law. This bill requires health insurers to cover a broader group of mental illnesses including addiction and substance abuse. “This would make CA the nation’s leader on mental health and addiction coverage,” said a group co-sponsoring the bill. Read more about this bill and the mental health benefits it added.
Information from the Centers for Medicare and Medicaid Services found that across all U.S. Affordable Care Act health insurance plans in 2020, 20% of the medical necessity denials were for behavioral health services.
Insurance Companies in Los Angeles Not Covered
The Mental Health Parity Act only applies to state-regulated health care service plans and insurance plans that are regulated by the state. Self-funded plans, such as those that are through large employers or unions, are not included under this Act. Medicare, Veterans Administration Programs, and Medi-Cal are also not included.
However, Federal parity laws may apply to some plans or programs that are not mandated by California’s Mental Health Parity Act. A Los Angeles mental health claims denial attorney can help insured individuals determine whether their health insurance benefit plan falls under Federal or California Health Parity laws.
What to Do After a Mental Health Care Denial
Insured individuals do have options if their mental health claim is denied by their insurance carrier. They can file a formal complaint with their health insurance provider. Under federal laws, the health insurance company should have a formal way of reviewing and addressing these complaints.
Depending on the type of plan, they may be able to appeal the decision at least once, if not twice. However, whenever a claim is denied it is best to consult a Los Angeles mental health claims denial attorney who can review the policy and help determine the best path forward.
How a Los Angeles Mental Health Claims Denial Attorney Can Help
A Los Angeles mental health claims denial lawyer can work to help you get your mental health claim accepted and paid. A lawyer who is well-versed in federal and California insurance laws can use their knowledge to help you seek justice when it comes to mental health claims.
If your insurance company denied a mental health claim, contact our offices today. We can examine the circumstances surrounding your claim to determine the best course of action to take. We work with people who are denied counseling, intensive outpatient programs, residential treatment center programs, and more.
We Take Pride in Representing People With Mental Illness
We have a track record of representing both adults and children living with mental illness throughout California in legal actions. Many of these suits have been against the largest insurers including Anthem Blue Cross, Blue Shield of California, Kaiser, HealthNet, and others, for coverage of mental health services. For example, we represented a young man living with obsessive-compulsive disorder who brought suit in Los Angeles Superior Court on behalf of himself and thousands of Kaiser members living in California with a severe mental illness against Kaiser for its deficient mental health services. The suit hoped to end Kaiser’s policy of denying regular individual psychotherapy for those living with mental illness.
We are grateful that we can continue to represent those living with mental illness who are being taken advantage of by others.
