Common Parity Violations
“I have a separate deductible for behavioral health services that is not part of my overall deductible.”
Possible Violation: It may be a parity violation if your insurance plan makes you pay separate deductibles for behavioral health services and other medical services.
“My co-pay for behavioral health services is higher than it is for other health services.”
Possible Violation: It may be a parity violation if your insurance plan requires a more expensive copayment or coinsurance for behavioral health services than what you are required to pay for other medical care.
“I have limits on how many days I can stay in a treatment facility.”
Possible Violation: If your insurance plan does not have the same limits on how many days you can stay in any other kind of inpatient medical facility, it may be a parity violation.
“I have limits on how many times I can see a behavioral health provider.”
Possible Violation: If your insurance plan does not have the same limits on how many days you can stay in any other kind of inpatient medical facility, it may be a parity violation.
“I’m being charged more for prescription medication for behavioral health treatment than I am for prescription medication for other treatments.”
Possible Violation: It may be a parity violation if your insurance plan charges you more for prescription medications simply because they are used for behavioral health treatment.
“My insurance plan often makes me get their permission to continue behavioral health treatment.”
Possible Violation: If your insurance plan orders medical necessity reviews for behavioral health services more often than for other health services, it may be a parity violation.
“My insurance plan refuses to pay for residential behavioral health treatment that my doctor says I need.”
Possible Violation: If your insurance plan will not cover residential treatment or partial hospitalization for behavioral health services, but it does for other medical services, it may be a parity violation.
“My doctor says I need a certain behavioral health treatment, but the insurer says I need to try a less expensive treatment first.”
Possible Violation: If your insurance plan requires you to try a less expensive treatment before it will cover the treatment recommended by your doctor, it may be a parity violation.
“My insurance plan won’t pay for behavioral health treatment outside of my state or region.”
Possible Violation: If your insurance plan puts geographical limits on where you can receive behavioral health services but does not do the same for other medical services, it may be a parity violation.