Washington, D.C., April 22, 2021 –Today, The Kennedy Forum and the National Alliance on Mental Illness (NAMI) released a new report titled: “The Health Insurance Appeals Guide: A Consumer Guide for Filing Mental Health and Substance Use Disorder (MH/SUD) Appeals.”
Individuals with mental health and substance use disorders often face barriers when seeking treatment, including health insurance denials that force them to go out-of-network and/or pay high out-of-pocket costs. In fact, a 2019 report from Milliman, Inc. found that patients had to go out of network more than five times more often for behavioral health care than for physical health care. At best, these coverage obstacles are time-consuming and expensive; at worst, they prevent people from getting potentially lifesaving care.
As former U.S. Rep. Patrick J. Kennedy, founder of The Kennedy Forum, explains: “The health insurance system in the United States has never covered mental health and substance use disorders appropriately…historically high rates of suicides and overdoses in this country are evidence of our failure to properly acknowledge, prioritize, and treat the brain on par with the body.”
While The Kennedy Forum, NAMI, and other organizations are dedicated to creating a future where such inequities no longer exist, it is critical that consumers know what to do when they feel they have been wrongfully denied coverage of mental health and addiction care. The new Guide, written by leading health insurance experts, provides detailed information for consumers, providers, and other stakeholders about the process of filing appeals.
“Many people don’t realize they can actually challenge their insurance plan when they are denied care or forced out-of-network. It is your right to challenge those decisions. This Guide is intended to help you know your rights and navigate the appeals process to get the affordable care you and your family deserve,” said Daniel H. Gillison Jr., CEO of NAMI.
The Guide’s eight sections include general background and terminology pertaining to health insurance plans; detailed overviews of the clinical and administrative appeals processes; information about the 2008 Mental Health Parity and Addiction Equity Act (Federal Parity Law); best practices for filing an appeal letter; and frequently asked questions.
While the U.S. navigates the mental health and addiction fallout of COVID-19—and continues to grapple with record rates of suicides and overdoses—access to affordable, quality care is critical. We hope this new resource empowers consumers to hold their health plans accountable. After all, there is no health without mental health.
NOTE: In addition to the Guide, you can find additional information at www.DontDenyMe.org.
About The Kennedy Forum
Founded in 2013 by former Congressman Patrick J. Kennedy (D-R.I.), The Kennedy Forum leads a national dialogue on transforming the health care system by uniting mental health advocates, business leaders, and government agencies around a common set of principles, including full implementation of the Federal Parity Law. Launched in celebration of the 50th anniversary of President Kennedy’s signing of the landmark Community Mental Health Act, the nonprofit aims to achieve health equity by advancing evidence-based practices, policies, and programming for the treatment of mental health and addiction. The Kennedy Forum’s “Don’t Deny Me” campaign educates consumers about their rights under the Federal Parity Law and connects them with essential appeals guidance and resources. To learn more about The Kennedy Forum and donate, please visit www.thekennedyforum.org.