What Every Person Needs to Know About Their Rights to Mental Health Coverage

By: Nicole Carrillo, Staff Attorney, Disability Rights California
drcDid you know that approximately one in five people have a mental health disability? About one-third of Californians go without mental health treatment. Few are aware of the right to equal insurance coverage or how to advocate for it; this prevents people from getting what they need.

There are two mental health parity laws that apply to Californians: a state parity law and a federal parity law. Which law applies depends on the type of health plan and who provides coverage.

What is Mental Health Parity?
It means equal insurance coverage for mental health care. State and federal parity laws require that health plans provide mental health benefits equal to those for other health benefits.

For example, plans cannot make you pay more for mental health therapy appointments than you pay for physical health appointments. This doesn’t mean services are exactly the same; mental health services don’t always have an equal in other health services. What it means is a plan cannot make it more difficult or expensive to receive medically necessary mental health services.

California Parity Law

The 1999 California Mental Health Parity Act applies to California’s state-regulated private insurers. It does not include “self-funded” plans; nor does it include federal programs such as Medicare, Medi-Cal, or Veterans Administration programs. Federal parity laws may apply to plans or programs not covered by California law.

What must be provided under California law?

Required benefits include outpatient services; inpatient hospital services; partial hospital services; and prescription drugs as long as they are included for physical conditions. The plan must cover all “medically necessary treatment” for “severe mental illnesses” such as residential care.[1] If your health plan isn’t providing equal coverage – you can take action.

You Have the Right
• To diagnosis and medically necessary mental health treatment
• To change your doctor if you are not satisfied
• To see and get a copy of medical records
• To get a second opinion
• To challenge a health plan coverage denial

Did you know?
Disability Rights California helps with mental health parity issues by providing counsel and advice, technical assistance to file complaints, and direct representation in select cases raising systemic issues. For more information on our mental health parity project contact Margaret Johnson.
Phone: (916) 504-5800
Email: [email protected]

Our parity project is funded by county mental health departments with Mental Health Services Act prevention and early Intervention funds provided through CalMHSA.

 

[1] See Harlick v. Blue Shield of California, 686 F.3d 699 (9th Cir. 2012).


 

nicoleNicole Carrillo is a staff attorney with the Advocacy Unit at Disability Rights California where she focuses on advocating and educating California’s diverse communities about mental health parity law to prevent and reduce discrimination. Nicole earned her B.A. in English from the University of Nevada Las Vegas and her J.D. from Golden Gate University School of Law. Personal experience has given her the passionate commitment to breaking through the barrier of discrimination, for herself and others. Nicole can be reached at 1-800-776-5746 or 916-504-5972.

 

*Guest blog: Each Mind Matters provides a platform for open dialogue and varying perspectives about mental health. The opinions of the author of guest blogs don’t necessarily reflect those of Each Mind Matters. If you have questions or comments about a blog written by a guest writer we encourage you to continue the discussion with the author by contacting the organization listed in the bio.