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Today, the National Alliance on Mental Illness (NAMI) and The Kennedy Forum released a new report titled “The Health Insurance Appeals Guide: A Consumer Guide for Filing Mental Health and Substance Use Disorder (MH/SUD) Appeals.” This resource is meant to help individuals and families understand what options they have to appeal when insurers deny coverage for mental health or substance use care.
Individuals with mental health conditions and substance use disorders often face barriers when seeking treatment, including health insurance denials that force them to go out-of-network and/or pay high out-of-pocket costs to get the treatment they need. At best, these coverage obstacles are time-consuming and expensive; at worst, they prevent people from getting potentially lifesaving care.
Therefore, it is critical that individuals and families know what to do when they feel they have been wrongfully denied coverage of mental health and addiction care. The new Guide, written by leading health insurance experts, provides detailed information for peers, families, providers, and other stakeholders about the process of filing appeals with insurance companies.
The Guide’s eight sections include general background and common terms related to health insurance plans; detailed overviews of both the clinical and administrative appeals processes; information about the 2008 Mental Health Parity and Addiction Equity Act (Federal Parity Law) and what it requires; best practices for filing an appeal letter with your insurance; and frequently asked questions.
While the U.S. navigates the mental health and addiction fallout of COVID-19—and continues to grapple with record rates of suicides and overdoses—access to affordable, quality care is critical. NAMI hopes this new resource empowers peers and families to hold their health plans accountable. After all, there is no health without mental health.