Federal and state mental health parity laws ensure that health plans treat mental health (MH) and substance use disorders (SUD) the same way they treat medical and surgical care.
As well, insurance companies cannot use more restrictive methods when they develop and apply provider reimbursement rates. Parity requires equity for:
Financial requirements
- Deductibles
- Copayments
- Coinsurance
- Out-of-pocket limits
Treatment limits
- Limits on the number of days or visits
- Other limits on the scope or duration of treatment
- Prior authorization
- Medical necessity
- Step-therapy
- Reimbursement rates
Next-day appointment referrals
In addition to complying with federal and state mental health parity laws, health plans must work with providers and their patients experiencing an urgent behavioral health condition to connect patients to a next-day appointment.
As a healthcare provider, you can help your patients access these next-day appointments by contacting their insurance company and making a referral.