KNOW YOUR RIGHTS TO MENTAL HEALTH BENEFITS...THEN FIGHT FOR THEM

Posted By || 21-Jan-2015

The American Psychiatric Association ("APA") released their poster for Mental Health Parity and knowing your rights.

The poster outlines 10 key elements of the Mental Health Parity and Addiction Equity Act 2008 ("MHPEA") and how to identify whether your insurance company has potentially violated this law. We implore anyone who has been denied coverage by their insurer on the basis of mental health not being a covered benefit to look at this poster and if you suspect your rights are being violated, contact us for a free consultation.

At Kantor & Kantor, we have fought tirelessly on this issue. You may recall in June 2014, Lisa Kantor appealed the granting of a demurrer with prejudice in the matter of Marissa Rea v. Blue Shield of California. The trial court had concluded that California's Mental Health Parity Act did not require insurers to provide residential treatment for persons with severe eating disorders. This decision was inconsistent with the Ninth Circuit decision in Harlick v. Blue Shield of California, 656 F.3d 832 (9th Cir. 2011), cert denied March 4, 2013, a case that Lisa had argued and won. Harlick held that the California Mental Health Parity Act, California Health & Safety Code Section 1374.72 and Insurance Code Section 10144.5 ("Mental Health Parity Act"), required that a health care service plan or health insurance policy issued, amended or renewed after July 1, 2000, that provides hospital, medical or surgical coverage shall "provide coverage for the diagnosis and medically necessary treatment of severe mental illnesses." "Severe mental illnesses" include major depression. Under the Mental Health Parity Act, health care service plans and insurance policies must provide all medically necessary treatment, including residential treatment, for members who are suffering from severe mental illnesses, such as major depression. The Ninth Circuit confirmed that the Mental Health Parity Act requires health care service plans to provide coverage for residential treatment for severe mental illnesses when such treatment is medically necessary, notwithstanding the provision in a plan that purports to exclude such treatment.

On June 10, 2014, in a published decision, the California Court of Appeals reversed the trial Court, and found in favor of Marissa Rea by stating that the Mental Health Parity Act mandated "treatment of mental illnesses sufficient to reach the same quality of care afforded physical illnesses." The decision in Rea, affirms the breadth of the Parity Act for people suffering from severe mental illnesses, including anorexia and bulimia nervosas.

These are just a couple of examples of cases we have won which have had huge impact on Mental Health Parity Laws. We should never allow our rights to be violated by insurance companies, simply because they can. The bottom line is they "can" unless we stop them.

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