Parity Complaints

California psychiatric association's Recommendations for Filing Mental Health Insurance Parity Complaints

The two most common reasons for appeals are lack of access to a contracted or network provider and denial of coverage for a recommended treatment (office visits, medication or hospital days).

1.  TALK TO THE PLAN FIRST. The patient and/or physician needs to use the appeals
and grievance system offered by the insurance company or health service plan first.
Keep records of phone calls (date, time, subject, and disposition) made or written
appeals filed.  Advise the plan representative of your intent to pursue your additional
appeal rights with the Department of Managed Health Care/State regulator. Note: CMA
members have added resources for claims issues*.

2.  CALL OR EMAIL THE REGULATOR SECOND. If the insurance company or health
plan fails to respond in a timely fashion, or if they inappropriately deny care despite your
appeal, file a complaint with the Department of Managed Health Care Help Center at
www.dmhc.ca.gov or 1-888-466-2219. (Note that the Help Center can expedite appeals
identified as urgent).  Also, note that if the insurance turns out to be the responsibility of
the Department of Insurance (or other agency) the DMHC Help Center will pass it on to
the appropriate agency.

3.  MATERIALS TO SUPPORT YOUR APPEAL. You should attach a copy of the
insurance company's denial letter or bill, or other pertinent documents if available, to the DMHC.  The web-based complaint form allows you to attach these documents.

4.  PRINT OR ASK YOUR PATIENT FOR A COPY OF YOUR COMPLAINT. If the
complaint is submitted electronically through the website, a copy MUST be printed
before you hit the send button – you will not be able to print once you hit send. Keep
that copy safe for reference.

5. NOTIFY CPA. Randall Hagar is tracking trends in complaints. So please send him a
copy of the complaint. (randall-hagar@calpsych.org). He can also help you facilitate
investigations.

6.  LET US KNOW THE OUTCOME. Let Randall Hagar (randall-hagar@calpsych.org)
know the result of any investigation and/or adjudication whether you win or lose on your
complaint. We will be monitoring those trends as well.

*CMA Reimbursement assistance services for CMA Members: economicservices@cmanet.org; hotline (888) 401-5911; http://www.cmanet.org/resources/