The California Mental Health Parity Act Toolkit: A Guide to Appealing Health Plan Mental Health Care Denials
Private health insurance must cover mental health equal to physical health conditions. This is "mental health parity.”This pub tells you about the California Mental Health Parity Act. It has information to help people get the mental health services they need. It is for people with private health plans regulated by California. It tells you what parity means. It tells you how to appeal. It gives you sample letters and appeals. This pub does not cover Medi-Cal.
This toolkit provides practical information and tips to help people get the mental health services they need. This toolkit is for people with private health plans regulated by the State of California and subject to the requirements of the California Mental Health Parity Act. It covers the following:
- what mental health services your health plan must cover under the California Mental Health Parity Act;
- what additional mental health services your health plan may cover, and
- how to appeal when your health plan denies your request for a mental health service that you need.
There are two mental health parity laws that apply to Californians, a federal parity law and a state parity law. Which parity law applies in your situation will depend on the type of health plan you have and who is providing the coverage. The focus of this toolkit is California’s mental health parity law. See page 4 for a description of the health plans covered by the California law. For a resource guide (https://parityispersonal.org/answers/resources) addressing the federal mental health parity law, please see.
This publication does not cover Medi-Cal. For information about your Medi-Cal mental health parity rights, see our website at https://www.disabilityrightsca.org/publications/medi-cal-managed-care-plans-mental-health-and-substance-use-disorder-benefits-and-your.
The toolkit first talks about what parity means and how it affects a person’s mental health plan coverage. The next section is about how to use the toolkit. It then discusses the California Mental Health Parity Act. The last major section is about the appeals process, and it includes sample letters and appeal documents.
What is mental health parity?
Mental health parity means a health plan must provide equal coverage for mental health and physical health. For example, health plans cannot make you pay more for mental health therapy appointments than they make you pay for physical health appointments. This does not mean the services provided are the exact same; mental health services do not always have an equal in physical health services. What this means is a health plan cannot make it more difficult to receive medically necessary mental health services. It also means a health plan cannot make it more expensive to receive those services.
How to Use This Toolkit
The information in the toolkit is a guide to appealing a negative decision by a health plan subject to the California Mental Health Parity Act. The first half of the toolkit gives information about the law, the appeals process and general reference information.
The second half is the Appendix. The templates in the Appendix are meant to be carefully reviewed by consumers, their families, their advocates and providers and altered to fit the unique facts of each situation.
Each template includes an opinion letter drafted by the team of legal services agencies that worked to create this toolkit. We encourage you to use the letters to help you support your position when filing an appeal. These letters contain customizable sections where you can include facts to tailor the letters to your specific situation.
Also included are checklists designed to assist you with resolving disputes with your health plan. The authors would like to thank the Parity Implementation Coalition for providing guidance on the checklists. The checklists have been developed based on the Coalition’s years of experience in assisting with mental health parity issues. Consumers should pay particular attention to the “Checklist for Keeping Track of My Appeal” located in the Appendix on page 24
Overview of California Mental Health Parity Act (CMHPA or the Parity Act)
Brief History of the CMHPA
The California Mental Health Parity Act, Assembly Bill 88 (AB 88), was signed into law in 1999. It requires every health plan that offers hospital, medical or surgical coverage to provide coverage for the diagnosis and medically necessary treatment of severe mental illnesses. The legislative history of AB 88 includes a letter from Assemblywoman Helen M. Thomson and Senator Don Perata to clarify the intent of the Parity Act. It says, in part, that “AB 88 was introduced in the spirit of bringing about fairness and equal treatment by the health plans and insurance industry” for those persons who have a severe mental illness. 6 Assemb. Journal, Cal. Leg., 1999-2000 Reg. Sess., 8115 (Aug. 23, 2000), Cal. Health & Safety Code § 1374.72 note, Cal. Ins. Code § 10144.5 note (West 2014).
Who and what is covered by the CMHPA
The CMHPA applies to all California health plans issued, amended or renewed on or after July 1, 2000, with some exceptions. It does not apply to “self-funded” employment-based plans, Medicare, Medi-Cal, Department of Veterans Affairs, or federal employee health plans.
California law requires that all medically necessary mental health services and treatments are covered equal to medical services. Equal does not mean a one -- to -- one comparison of services, but an equal quality of coverage. Rea v. Blue Cross of California, 226 Cal. App. 4th 1209, 1238, 172 Cal. Rptr. 3d 823, 845 (2014).
The law requires the benefits provided under the health plan be equal between medical and mental health services. The benefits covered by the statute include:
- Outpatient services
- Inpatient services
- Partial hospital services
- Prescription drugs, but only if there is a drug plan offered. There is no requirement to create a drug plan to comply with the parity law.
In addition to the four benefits listed in the statute, the courts have held insurers must cover medically necessary treatment services not listed in the statute, like residential treatment. Rea v. Blue Shield of California, 226 Cal. App. 4th 1209, 172 Cal. Rptr. 3d 823 (2014); Harlick v. Blue Shield of California, 686 F.3d 699 (9th Cir. 2012).
The terms and conditions applied equally to all benefits include, but are not limited to:
- Maximum lifetime benefits
- Individual and family deductibles
This means if the co-payment for an office visit with your physician is $30, then the co-payment for an office visit with your therapist must be $30.
There is, however, a limit to who receives the benefits of the parity law. The statute requires parity for all adult persons with a “severe mental illness” as defined in the Parity Act. For adults, the illnesses covered under the Parity Act are:
- Schizoaffective disorder
- Bipolar disorder (manic-depressive illness)
- Major depressive disorders
- Panic disorders
- Obsessive-compulsive disorder
- Pervasive developmental disorder or autism
- Anorexia nervosa
- Bulimia nervosa
The Parity Act protects children with a “severe emotional disturbance.” “Severe emotional disturbance” is defined more broadly than “severe mental illness” to include any disorder in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, other than a primary substance abuse disorder or developmental disorder. The emotional disturbance must also meet the criteria in Welfare & Institutions code § 5600.3(a)(2). This means the “severe emotional disturbance” must result in a substantial impairment in two or more categories and inappropriate behavior according to developmental norms.
Below are some examples of how the California Mental Health Parity Act requires equal treatments and services for mental health and medical/surgical health.
- A person with a diagnosis of major depression or anorexia nervosa submitted a request for prior authorization for outpatient intensive therapy. The outpatient intensive therapy must be provided comparable to the provision of outpatient intensive therapy for someone with a physical disability.
- A child with a diagnosis of severe bipolar disorder can receive medically necessary recommended in-home, intensive support services of the same quality as other outpatient medical/surgical care.
- A person with a diagnosis of schizophrenia can receive the same care for utilization and out-of-pocket expense for an intensive, inpatient hospitalization as someone with a need for intensive, inpatient hospitalization for a medical/surgical condition.
You have a legal right to challenge a coverage denial by a health plan, no matter what kind of health plan you have. For example, you have a right to challenge a coverage denial if you have an individually-purchased plan or an employer-paid plan. This includes plans available directly, or through a broker or an exchange, such as Covered California. Every plan is required to provide a process to reconsider or appeal a denial of coverage. The only question should be who to file the appeal with and which parity law applies. If California regulates your health plan, and you are diagnosed with one of the nine mental illnesses listed on page 5, this toolkit provides the materials to help you with your appeal. If you fall outside of these criteria, you most likely fall within the federal parity laws and the federal resource guide would be the best resource. The federal resource guide is located at (https://parityispersonal.org/answers/resources).
If you have a health care service plan, also called a managed care plan, or a Blue Cross or Blue Shield preferred provider organization (PPO) plan, your plan is probably regulated by the California Department of Managed Health Care (DMHC) and DMHC rules apply to your plan. If you have an indemnity insurance policy (also called a “fee-for-service” plan) including a PPO plan (other than a Blue Cross or Blue Shield PPO plan) your plan is probably regulated by the California Department of Insurance (CDI, or DOI), and CDI rules apply to your plan. The California Mental Health Parity Act provisions administered by DMHC and CDI are virtually the same, but are found in different places in the California codes. The statutes administered by DMHC are found in the California Health and Safety Code and the statutes administered by CDI are found in the California Insurance Code. DMHC and CDI apply federal mental health parity protections to all plans covered by the California Mental Health Parity Act and to all plans regulated by them that provide non-mandated mental health and substance use benefits.
If you receive your mental health services through Medi-Cal, the California law may not apply. However, the federal mental health parity protections apply, and the information in the federal parity resource guide applies. There is a separate process for Medi-Cal administrative hearings. This is beyond the scope of this publication. For more information about the Medi-Cal appeal process, please see the helpful links on page below.
If you receive your mental health services through a self-funded employer-based plan (such as a large private employer plan, a state or local government plan, or a union plan), only the federal mental health parity protections apply, and the information in the federal parity t resource guide applies. It is sometimes difficult to determine if a plan is self-funded or not. Usually, an employer or union will hire a third-party administrator (TPA) to operate the plan. The TPA is usually a health plan, for example, Blue Cross, Health Net, or UnitedHealthcare. The summary plan description for your health coverage will be issued by this health plan. Ask your plan administrator if the plan is self-funded or not.
Finally, federal government plans have separate parity requirements. The state requirements do not apply to these plans. Federal government plans include Medicare, Medicare Advantage, Medicare Supplement, Veterans Affairs, CHAMPUS, and Federal Employee Health Benefits Program plans administered directly by the federal government or through private insurers. Check your evidence of coverage or summary plan description documents to determine what your appeal rights are. You can also find information about appeal rights on the various plan websites.
Know your coverage documents
Understand the health plan coverage
Knowing what your plan will and will not cover, prior to a procedure or doctor’s appointment, allows you to make more informed decisions about your health care. Depending on your plan and your benefit, this information will be outlined on the health plan’s website or is available from your plan administrator or your employer’s human resources (HR) department. Information about what benefits your plan covers, and how to access care is usually outlined in a packet of information called the “Evidence of Coverage” (EOC) or “summary plan description” (SPD). Ask your broker, your plan administrator, or your employer’s human resources department where to find it if you cannot locate your EOC or SPD documents.
Know when you need to obtain prior authorization
It is your responsibility to know when you need prior authorization for a procedure or treatment, or to see a specialist, and to make sure you and your provider receive approval. You can find this information in the benefit plan documentation or by calling your health plan’s customer service.
It is not unusual for some claims to be denied, or for health plans to say they will not cover a test, procedure, or service that doctors order. When a health plan denies a claim, either through the prior authorization process or after the service has been completed (post-payment audit), you will get a denial notice. The notice will inform you that the health plan will not pay for the service and the reason for the denial. If the denial is based on medical necessity, the notice must contain the section of the medical necessity guidelines applicable to your situation.
If you do not receive a notice, but your provider or other party told you that your health plan denied your service or treatment, contact your health plan. There are only a few situations where the health plan is not required to provide a written notice. If denied coverage because of a specific exclusion, for medical necessity, or for an experimental or investigational treatment, the health plan must provide written notice. When contacting your health plan remember to write down whom you spoke to, when you called and what happened in the call. If the health plan confirms the denial, ask that they send you the denial in writing. If the plan refuses to send a written denial, or fails to send you the written denial, you can call the regulating agency for help (See page 23 for helpful links). The discussion about which agency to call is above on page 7.
Your first step when you receive a denial notice should be to refile the claim together with a copy of the denial notice. You may need a note or letter from your doctor or other provider to explain or justify what it is you need. Sometimes all that is needed is the service or treatment to be coded differently. If your challenge is not successful, you may need to:
- Delay your payment for the treatment until the matter is resolved.
- Re-submit the claim a third time and request a review.
- Ask to speak with a health plan supervisor who may have the authority to reverse a decision.
- Request a written response from the health plan explaining the reason for the denial.
- Get help from a customer service representative of the state agency that regulates your health plan. (See page 23 for helpful links).
- Formally appeal the health plan’s denial in writing, explaining why you think the health plan should pay for the treatment.
When contacting your health plan (i.e., when seeking general information to begin the appeal process), it’s important to try to develop a good working relationship with the plan representative(s). Below are some tips for getting answers to these coverage-related questions.
- Speak with your health plan’s customer service department.
- Ask for the name of the person with whom you are speaking each and every time you call.
- Make a note of the person’s name and the date and time of the call.
- Ask if there is a “reference number” for your call, and write down this number, if there is one.
- Ask your health care provider for help.
- Talk with the consumer advocacy office of the government agency that regulates your plan. Ask for and write down the names of the people you speak to. See the helpful links on page 23 of this toolkit for contact information.
- Learn about the health plan laws and regulations that protect you. See the helpful links below for further information.
Filing an appeal
Critical Information You Need BEFORE You File Your Appeal
BEFORE you call your health plan, make sure you have the following information.
- Know what type of health plan you have.
You need to know what type of health plan you have. This can be individual coverage, self-funded employer-based coverage, small group coverage, large group coverage or a public plan. See the checklist titled “Checklist for My Health Plan Coverage” on page 25 in the appendix.
- Understand the terms of the plan’s coverage documents (and what mental health and non-mental health benefits the plan does and does not cover).
- Obtain the medical necessity criteria for both the mental health and comparable medical benefit so you can compare how coverage decisions are made for both types of benefits.
- Obtain the plan’s reason for the denial of care.
Health plans have one and sometimes two levels of internal appeals. To file an appeal, most health plans have a standard form. Often the health plan will include the appeal form with the denial notice, or provide information on how to get the form. Use the checklist on page 26 to ensure you are providing all the information the health plan will need to evaluate the appeal.
When filing your appeal, remember these tips:
- Be persistent. Do not give up.
- Denials are often overturned on appeal. You may have to go through several steps in the appeal process to get the denial overturned.
- Keep you appeals factual and brief, but make sure you provide complete information.
- Meet all deadlines for filing an appeal.
- Keep detailed records. You can use the tracking sheet on page 25 to help with this.
- Ask for help from your health care providers.
If the internal appeal is not successful, in many cases you can request an external review. Your health plan will provide information about the right to external review in your Evidence of Coverage or Summary Plan Description documents. During an external review or “Independent Medical Review” (IMR), your denial is reviewed by doctors who are not part of your health plan. The agency that regulates your health plan is responsible for the external review.
You can apply for an IMR if your health plan denies, changes, or delays a service or treatment because:
- The plan determines the treatment is not a covered benefit under the terms of the plan
- The plan determines the treatment is not medically necessary
- The plan will not cover an experimental or investigational treatment for a serious condition
- The plan will not pay for emergency or urgent medical services that you have already received
Urgent Health Situations
If you have an urgent health situation and your health plan denied needed care, you can speed up the appeals process. These are situations where waiting for the standard appeals process could seriously jeopardize your life or your ability to regain maximum function.
You can request both an internal and external review at the same time. The timeline for a final decision is also shortened. A final decision must be reached as quickly as your condition requires, within a maximum of four (4) business days.
Your health plan may offer, or, in some cases, require that you settle your differences through a process called arbitration. This is where two parties present their views to a neutral third party – an arbitrator – who decides how to settle the differences. Your Evidence of Coverage or Summary Plan Description will have information about the arbitration process and whether it is binding or non-binding. Binding arbitration means that everyone agrees ahead of time to abide by the arbitrator’s decision. Non-binding arbitration means the decision is advisory only, and you don’t lose any other appeal rights.
If your health plan offers voluntary arbitration, you can choose to use it or not. If you decide not to use voluntary arbitration, it does not affect your rights to any other plan benefits, nor can your health plan use your decision against you in any subsequent appeals.
If your insurance plan makes arbitration mandatory, California may regulate how your plan can use arbitration. The agency that regulates your plan can provide additional information about the state requirements. Helpful links on page 23 has contact information for the Department of Insurance and the Department of Managed Health Care Services.
Steps to Take During an Appeal
Step #1 - Ask your provider to help you.
Your provider has the resources and knowledge to help you support your claim. S/he is able to provide information about your treatment needs that may convince your plan to cover your care or treatment. If your provider recommends a course of treatment, s/he has a professional obligation to help you get authorization or payment for the treatment from your health plan. Your provider may also have a legal obligation to help you with this as well.
Step #2 - Make sure your provider requests a special, expedited appeal for emergencies (see section on urgent health situations above).
Emergency care cannot be put off because of standard paperwork or decision-making processes. Most health plans provide this special appeals process, so use it when necessary.
Step #3 - Confirm with the health plan that it will cover services during the appeal.
If this is not possible, ask what your financial obligations will be for these services if the appeal is unsuccessful so you can discuss other options with your provider(s), as necessary.
Step #4 - Request, or have your provider request, written notification of the reasons for denial.
Your health plan should send both you and your provider a written explanation of the reasons for the denial. This notice should include a description of the information required for approval of your treatment. By providing this information in writing, it reduces the chances there will be a miscommunication between the health plan and you and your provider. This is a new right under the parity law. If you do not receive this within 30 days, complain to the entity regulating your health plan.
Step #5 - Use the templates in this toolkit.
This toolkit contains sample letters for appealing commonly denied mental health/substance use disorder claims and accompanying legal justifications.
Step #6 - Make sure that you and your provider(s) meet all deadlines.
If your treatment is denied because either you or your provider missed a utilization review or appeals deadline, that denial is rarely overturned, even if the health plan agrees treatment is necessary.
We know and understand that the appeal process can be frustrating and tedious. You will have to call your health plan, record all the information provided in those calls, track all your documents and write letters. But it is doable, and often quite successful. Get a notebook and find a place in your house to keep everything. Write notes of every call you make. Save every letter you receive. Stay calm and be pleasant. Take it one day at a time. Let us know if we can help. The partnering organizations’ contact information is in helpful links on page 23.
Terms to Know
Appealing a Claim: The process to contest a denied medical or mental health claim. Most health plans have their own process and timeline.
Balance Billing: The amount you could be responsible for (in addition to any co-payments, deductibles or coinsurance) if you use an out-of-network provider and the fee for a particular service exceeds the allowable charge for that service.
Carrier: The health care service plan or health insurance company that issues your health plan coverage.
Carve-Out: - An independent managed behavioral health organization that manages mental health or substance use benefits separately from the plan’s medical benefits.
Claim: A description of care provided, or to be provided, or a request for payment, typically submitted by the provider to the patient’s health plan. Claims are reviewed by the health plan in order to determine whether the services are covered and ultimately whether the health plan will authorize payment for the services to the provider.
Classification: One of the four categories of benefits required under the CMHPA (i.e., inpatient, outpatient, partial hospitalization, or prescription drug coverage).
Clinical Practice Guideline: A utilization and quality management tool designed to help providers to make decisions about the most appropriate course of treatment for a particular patient with a particular condition or conditions.
Co-payment: The dollar amount that a patient with health care coverage is expected to pay at the time of service.
Deductible: A dollar amount (usually an annual amount) a patient with health care coverage must pay before the health plan will make any payments.
Denied Medical Claim: Rejection of a request for reimbursement of health care services delivered to the patient with health care coverage. The health plan often informs the patient of the rejected claim and explains why the services are believed to be outside of the scope of those covered by the health plan.
Effective Date: The date your health coverage is to actually begin. You are not covered for any services until the effective date.
Employee Assistance Programs (EAPs): Mental health counseling services that are sometimes offered by health plans or employers. Typically, individuals or employers do not have to pay directly for services provided through an employee assistance program.
Employee Retirement Income Security Act (ERISA): A comprehensive federal law that regulates employee welfare benefit plans, including self-funded health plans, and establishes the rights of health plan participants, requirements for the disclosure of health plan provisions and funding to participants, and standards for the investment of plan assets.
Evidence of Coverage (EOC): A packet of information about your health plan, which summarizes covered and excluded benefits. This packet outlines the rules and procedures for accessing benefits through your health plan, and also describes the grievance and appeals processes. Under some plans, this type of information is called a summary plan description.
Exclusions: Specific conditions, services or treatments, listed in the plan documents, for which a health plan will not provide coverage.
Exclusive Provider Organization (EPO): In an EPO you must use the providers who belong to the EPO or your expenses will not be covered. In other words, you cannot go “outside” the network for medical care.
Explanation of Benefits: A statement sent from the health plan to a plan member listing services that were billed by a health care provider, how those charges were processed, and the total amount of patient financial responsibility for the claim.
External Review: External review is part of the health plan claims denial process. It typically occurs when an independent third party reviews your claim to determine whether the health plan is obligated to pay. External review is one of several steps that comprise the appeal and review process. It is performed after you have exhausted the plan’s internal review process without success. It is an appeals review that is conducted by a third party that is not affiliated with the health plan or a providers' association and has no conflict of interest or stake in the outcome of the review.
Financial Requirements: Amounts the patient is responsible for paying, such as deductibles, copayments, coinsurance, and out-of-pocket maximums.
Formulary: A listing of drugs, classified by therapeutic category or disease class, that are considered preferred therapy for a given condition and that are to be used by a Managed Care Organization's providers in prescribing medications.
Fully Insured plan: Employer-based health care coverage purchased through a commercial health plan. These plans are regulated by states. In California, fully-insured plans are regulated either by the California Department of Managed Health Care or the California Department of Insurance, depending on the type of plan.
Affordable Care Act (ACA): A federal law that, among other things, outlines the requirements that employer-sponsored group health plans, health insurance companies, and managed care organizations must satisfy in order to provide healthcare coverage in the individual and group health care markets.
Health Maintenance Organization (HMO): A type of health plan in which you access all or most of your care from a designated network of providers, and you generally go through your Primary Care Physician to get referrals to other providers.
Inpatient: A term used to describe a person admitted to a hospital for at least 24 hours, or overnight. It may also be used to describe the care rendered in a hospital when the duration of the stay is at least 24 hours, or overnight.
Managed Behavioral Health Organization (MBHO): A carved-out managed care organization that provides behavioral health services for a health plan.
Medicaid: A joint federal and state program that provides hospital, medical, and other services to certain individuals with limited income, including individuals age 65 and older, and individuals younger than age 65 with certain disabilities. In California, this program is called Medi-Cal.
Medically Necessary: Medical services that are essential or required for the diagnosis and/or treatment of a medical condition.
Medicare: A federal government program established under Title XVIII of the Social Security Act to provide hospital and medical insurance to persons who are age 65 or older, or persons younger than age 65 with certain disabilities.
Network: The group of physicians, hospitals, and other medical care professionals that a managed care plan has contracted with to deliver medical services to its members.
Non-Quantitative Treatment Limitation: Any non-financial treatment limitation imposed by a health plan that limits the scope or duration of treatment (i.e. prior authorization, medical necessity, utilization review etc.)
Out-of-Plan/Out-of-Network: Physicians, hospitals, and other health care providers that are not contracted with the health plan to provide health care services.at negotiated rates or rates approved by the plan. Depending on an individual’s plan, expenses incurred for services provided by out-of plan health care professionals may not be covered, or may be only partially covered.
Outpatient Care: Treatment that is provided to a patient who is able to return home after care without an overnight stay in a hospital or other inpatient facility.
Partial Hospitalization Services: Also referred to as "partial hospital days," this is a health care term used to refer to outpatient services performed in a hospital setting as an alternative or follow-up to inpatient mental health or substance use treatment.
Point-of-Service (POS): Managed care plans that contract with out-of-network providers for certain specialty services that you need are called POS plans.
Prior Authorization: Confirmation of coverage by the health plan for a service or product before you receive the service or product from the health care provider. Also known as pre-authorization.
Preferred Provider Organization (PPO): A type of health plan where you can access care from a list or network of “preferred” providers, at a lower cost than accessing care from providers outside of that network.
Provider Payment: Amount of money paid to the health care provider by the health plan.
Quantitative Treatment Limitation: Financial requirements such as co-payments, coinsurance, deductibles that must be paid by plan participants.
Reasonable and Customary Fees/Usual and Customary Fees: The average fee charged by a particular type of health care practitioner within a geographic area. These fees are often used by insurers to determine the amount of coverage for health care provided by out-of-network providers. The individual may be responsible for any copayment, coinsurance and deductible, as well as any remaining portion of the provider’s fee that is not covered by the Reasonable and Customary Fee.
Reason Codes: A letter or number system typically presented and defined at the bottom of an Explanation of Benefits, used to explain how the claim for coverage or payment was processed. These codes are very important in understanding why the health plan denied all or part of your claim.
Self-insured plan (ERISA): A plan offered by employers or unions who directly assume the major cost of health care for their employees or members. Self-insured employee health benefit plans are exempt from many state laws and instead are subject to federal ERISA law.
Summary Plan Description (SPD): A description of the benefits included in your health plan. Under some plans, this type of information is called Evidence of Coverage.
Treatment Limitations: Limits based on frequency of treatment, number of visits, days of coverage, days in a waiting period.
Note: This list of terms it not intended to be exhaustive. These terms are useful in understanding the parity law and navigating the appeals process.
California Department of Insurance (CDI) consumer page: http://www.insurance.ca.gov/01-consumers/110-health/
For information about PPOs, POSs and EPOs or to file a complaint about this kind of plan
California Department of Managed Health Care (DMHC) page on mental health care.
https://www.dmhc.ca.gov/HealthCareinCalifornia/GettheBestCare/MentalHealthCare.aspx For information about HMOs and Blue Cross of California’s PPO and Blue Shield’s PPO or to file a complaint about this kind of plan.
Disability Rights California: www.disabilityrightsca.org
Legal Aid Society of San Diego: https://www.lassd.org/area/mental-health
Law Foundation of Silicon Valley Mental Health Advocacy Project: http://www.lawfoundation.org/mental-health-advocacy-project-mhap/
Mental Health Advocacy Services, Inc.: www.mhas-la.org
State Laws Mandating or Regulating Mental Health/Substance Use Disorder Benefits: http://www.ncsl.org/IssuesResearch/Health/StateLawsMandatingorRegulatingMentalHealthB/tabid/14352/Default.aspx
U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA): www.samhsa.gov
For information about substance use and mental health generally.
Checklist for Keeping Track of My Appeal
Checklist For My Health Plan Coverage
Phone Call Log
Model Appeal Letters
Click links below for a full downloadable version.