We the Patients

Parity a blog post

PARITY 101: Why “Parity” needs to become verbal ammo in your fight for fair Mental Health and Substance Use Disorder insurance coverage

You might not know it yet, but “Parity” is an important term when it comes to mental health, substance abuse disorder, and insurance benefits.

Knowing about Parity—a term which is shorthand for a federal law that’s been quietly on the books since 2008—is as important as knowing your right to remain silent, your right to refuse unlawful search and seizure, your right to no surprise bills for out of network emergency medical coverage.

Luckily, the easiest way to remember its significance is right there in the dictionary: parity is “the quality or state of being equal or equivalent.”

And that’s what this law is all about: equality of insurance coverage for those with mental health and/or substance abuse issues. Formally known as the Mental Health Parity and Addiction Equity Act of 2008. The full name is a mouthful, yes, but if you or someone you care about ever suffered depression, tried to live with untreated schizophrenia, or got lost in the apparent hopelessness of drug or alcohol addiction, it’s the most important mouthful in your insurance vocabulary.

In plain language, the MHPAE Act requires insurance companies that offer mental health and substance abuse disorder treatment to provide equal coverage no matter what the condition. Repeat chemotherapy visits for chronic cancer or repeat treatment for chronic drug addiction? It doesn’t matter your illness. You are entitled to equal rights from your insurance company. The precise biological origin of the issue—a cancer cell gone wild with DNA replication or criss-crossed neural pathways muting your serotonin response—no longer matters. Your insurance company is legally obligated to cover the cost of your treatment. Equally.

Here are some very important things you need to know about The Parity Act:

  1. Inevitably, the Parity Act has limits. The law applies only to employer-provided group healthcare plans. That means if you are self-employed your insurance company may provide equal mental health/substance abuse disorder coverage, but it can’t be federally compelled to.
  2. Your insurance company is also not required to provide mental healthcare/substance abuse coverage. The law does not compel that. It only compels the insurance company to provide comparable, equal coverage IF your group insurance plan includes it.
  3. This is a larger issue we hope to tackle here, but one thing Parity does acknowledge, albeit implicitly: You are not weak for needing rehab for addiction issues or hospitalization for mental health issues. Do not let your insurance provider even begin to suggest you deserve some of the blame—and so less of the coverage—because any of your health issues are your fault, a result of weakness, sinfulness, lack of willpower, etc. Any time you speak to your insurance company, remember Parity, and ask them if they would say the same to a cancer patient. No one asks to be unwell. Get all the help you need—and that includes all the financial help your insurance company is federally mandated to provide. They can save their moralizing for another day of the week.
  4. As is depressingly often the case, insurance companies will still try to sneak out of paying for coverage in spite of the Parity Act. As recently as February of this year, a class action lawsuit (Wit vs. United Behavioral Health) was finally decided, with the judge in the case ruling against United Behavioral Health for using excessively stringent standards to deny parity in mental health and addiction coverage to thousands of its fully paying, fully insured customers (all of whom suffered, some of whom died trying to receive treatment). Granted it’s good news the judge ruled against United Behavioral Health—and likely precedent-setting. If you’re confronted with that situation, cite this case.
  5. Parity in insurance coverage is still evolving, but you are not in this alone. Complain to your insurance company, call the Health Care Bureau of the New York State Attorney General’s Office at 1-800-428-9071 with any issues regarding getting coverage for your mental health and/or substance abuse disorders from your insurance provider. You can also fill out this complaint form and submit it online (you can optionally print and mail it).

FURTHER READING:

Here are some helpful breakdowns of Parity and links for use in case of issues in getting coverage, etc.