Nonprofit ยท National Alliance on Mental Illness
National Alliance on Mental Illness guide to insurance denials
A plain explanation of why mental health care is denied, five signs of a possible parity violation, and a link to a longer appeals guide written with The Kennedy Forum. Information only.
Know before you go
The page defines medical necessity criteria, utilization review, prior authorization and step therapy, and lists five signs you may have grounds to appeal under parity law, such as higher costs or fewer visits for mental health care than other care. It says most health plans are required to follow federal and state parity laws. It points to a longer guide to download. It gives information; it does not appeal for you.
- Cost
- Not stated
- Where
- Nationwide
- How to start
- Read the page, compare your situation to the five signs, then download the linked appeals guide for the full steps and sample letters.
- Have ready
- The denial letter; Your plan's description of benefits; Notes on what you were told about medical necessity
Where this comes from
- Provider
- National Alliance on Mental Illness
- Source we read
- https://www.nami.org/living-with-a-mental-health-condition/understanding-health-insurance/what-to-do-if-youre-denied-care-by-your-insurance/
- Date we read it
- . This is not a fresh check.
- Date the provider printed
- Not displayed
- What we checked
- We read the provider's public page. We have not verified availability, eligibility or outcomes for any individual.
Other starting points
- Program or service
FAIR Health Consumer cost estimates
A nonprofit's tools for estimating what providers charge and what insurers pay in your area, plus insurance basics. Useful evidence in an out-of-network payment dispute. It does not file appeals or negotiate for you.
From FAIR Health
- Program or service
Legal Action Center free legal help in New York
Free legal help for New Yorkers with substance use disorders or mental health care needs, including insurance barriers to treatment. Nationwide help is limited to certain addiction-medication cases.
From Legal Action Center
- Program or service
No Surprises Help Desk: surprise bill questions and complaints
The federal help desk for questions or complaints that a plan, provider or facility broke the surprise billing rules. It reviews the complaint and may refer it to another federal or state enforcer.
From Centers for Medicare & Medicaid Services