Ask Wendell: The Mental Health Parity Act may save the day
Many of the inquiries “Ask Wendell” has received pertain to mental health and behavioral issues. Until recent years, insurers in general provided little or no coverage for treatment of mental illnesses. It took an act of Congress—literally—to change that. The Mental Health Parity Act (MHPA), which became law exactly 15 years ago today, requires that annual or lifetime dollar limits on mental health benefits be no lower than the dollar limits for medical and surgical benefits offered by a group health plan.
Because insurers were finding ways to get around the law’s requirements—they were, for example, limiting the number of provider visits and the number of days they would cover for inpatient psychiatric hospitalizations—Congress amended MHPA three years ago by closing some loopholes. Nevertheless, many Americans with mental health problems still face more coverage limitations than those with physical illnesses, as the letter below illustrates. If that is happening to you, fight back.
Dear Wendell,
My son was diagnosed with severe psychotic depression. He is slowly recovering, but he still has a way to go and does best when he can see his psychiatrist four times a week. Anthem Blue Cross will only pay for two sessions a week. We've tried to fight this, but they won't budge, saying their psychiatrist has decided my son's condition only warrants twice weekly sessions. Their psychiatrist has never met my son, so how can they justify this judgment call? Is this legal? How can they justify this when there is no longer a cap on the amount of treatment? Is there any way we can fight this?
Dear Lisa,
What your son is experiencing is a practice in the insurance industry known as "partial denial," and it very possibly could be illegal. As a first step, you should initiate an appeal right away. But don’t stop there or even wait for the results. Become a “squeaky wheel.” Insurers hate squeaky wheels. Anthem executives very possibly will agree to the number of sessions your son’s psychiatrist believes is necessary when they realize you will squeak long and loud if they don’t.
Appeal Insurance Denial Health Letter - News
The individual mandate, considered the linchpin of the law, requires everyone to have health insurance by 2014. In its petition filed Wednesday, lawyers for the Obama administration said the appeals court decision is "fundamentally flawed.
Under President Barack Obama's health overhaul law, consumers have the right to know why an insurance claim was denied, to appeal a denial to the insurance company and to take an appeal to an independent, third-party review. New Hampshire had been one
A group of holders of notes issued by now-defunct SONICblue, Inc. (the "1996 Bondholders") appeal the district court's grant of summary judgment to Admiral Insurance Company ("Admiral") on the basis of recision, and the district court's denial of the
What your son is experiencing is a practice in the insurance industry known as "partial denial," and it very possibly could be illegal. As a first step, you should initiate an appeal right away. But don't stop there or even wait for the results.
(MONEY Magazine) -- When a health insurance claim denial lands in the mailbox, do you figure the hassle of going to battle isn't worth it? Think again. Patients who appeal denials directly to the
How to File a Life Insurance Claim Appeal | Life Insurance Health
The first thing you should do if your life insurance claim is denied is contact your attorney. Your attorney can file an appeal on your behalf. Understanding how to file an appeal is important if you plan to do it yourself. Also, it’s important to know what the work entails, in case you want to file yourself.
Find out the Policy on AppealsYour denial letter should include information on how to file an appeal. If you still have questions, you can contact your insurance company by phone or in writing about the appeals process. Ask them to respond in writing by resending the denial letter or some other written document on the appeals process. There’s usually a time restriction in terms of how long you have to file an appeal, so get that information as quickly as possible.
Gather and Submit Supporting DocumentsYour denial letter should state why your claim was denied. Your job now is to provide additional or clarifying information and documents to get that denial overturned. It’s important to be as detailed as possible and focus on the reason for the denial, rather than just resubmitting miscellaneous information.
Once you file a life insurance claim appeal, you should follow up periodically to get a status report. Ask if any additional information is required and submit anything else the person handling your appeal needs.
Appeal Insurance Denial Health Letter - Bookshelf
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Sample letter for appealing a health insurance claim denial
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How to Appeal a Health Insurance Denial - Health - WSJ.com
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