Mental health parity implementation: We need your help
The APA Practice Organization (APAPO) is looking to identify potential plaintiffs for class action litigation addressing violations of the federal mental health parity law. APAPO is considering collaborating with state psychological associations on class action litigation that would include patients (and/or psychologists representing the interests of their patients) as plaintiffs representing the class.
APAPO is looking for psychologists who have experienced situations where patients were denied coverage for needed mental health services as described below. If one of your patients has suffered a “denial” of mental health care with all six elements described below, please email us describing briefly how the criteria below apply.
If you already responded to the parity survey released by APAPO last May, we have your information. But if you have a new denial or the facts of the old denial have changed significantly, please email us. Also, please email us if you are unsure whether or not you responded to the survey.
The specific types of “denials” we are seeking to address are instances where:
- The patient was covered by private insurance (not Medicare, Medicaid or Tricare), preferably with a relatively large insurer.
- The insurance company prematurely reduced or terminated coverage for the psychologist's services, denying coverage for the level and frequency of treatment recommended.
- The recommended treatment was, in the psychologist's opinion, medically necessary and appropriate. Preferably the patient had a fairly typical diagnosis and treatment.
- The patient or psychologist unsuccessfully appealed the denial (or there is still time to appeal).
- The denial harmed the patient in some way (for example, physical, emotional or financial harm) and
- The patient's plan was covered by the federal parity law, the Mental Health Parity and Addiction Equity Act (MHPAEA); see below.
What private insurance plans are covered by federal parity?
MHPAEA now applies to most but not all types of private insurance, including insurance offered through the new state or federal insurance exchanges created under the Affordable Care Act. The following are some common exceptions where MHPAEA does not apply to private insurance: small employer plans (50 employees or less); state employee plans (including plans covering state universities and teachers) where the plan has opted out of parity; and insurance not obtained through the employer or through a state insurance exchange (such as individual coverage or student coverage through school).
If there has been a “denial” as described above and you are unsure whether parity applies, please contact us at and we can help make that determination.