Health insurance companies owe a duty of care to their clients that includes providing for their mental health care needs. Nationwide, up to 1 in every 5 adults is expected to experience a mental illness in the course of any given year. Of these, it is estimated that up to 4% of adults experience a serious mental illness that substantially affects their ability to function and engage in normal activities.
When insurance companies deny or delay coverage for mental health services, they can be held liable for actions that are not in accordance with the law and for the consequences their denial causes for the patient or their family.
Mental Health Parity – Federal and State Laws
In 2008, the federal government passed the Mental Health Parity and Addiction Equity Act that strongly regulated health insurance companies that provide coverage for mental health care, addiction treatment, and behavioral problems. Most importantly, the parity law stipulated that health insurers could not use overly restrictive requirements for obtaining benefits.
Further, it stipulated that coverage for mental health care should be equal to the care and coverage provided for other medical or surgical treatments. More recently, provisions within the Affordable Care Act require that policies offered by health insurance exchanges (including Nevada) offer coverage for mental health care and substance-abuse disorders.
Under federal law, insurance companies are not allowed to require consumers to pay more for copays related to mental health care than they do for other types of appointments. Moreover, insurance companies are further restricted from establishing arbitrary limits on the number of appointments a patient can seek.
In Nevada, insurance companies are only mandated to provide coverage for severe mental illnesses and may not charge copays or deductibles that exceed 150% of out of pocket expenses.
Appealing a Denial of Coverage
It is not uncommon for health insurance companies to deny coverage for mental illnesses, diagnostic treatment, psychotherapy, or psychological rehabilitation. Often, a Reno health insurance lawyer can help successfully appeal the denial and help individuals secure the mental health care treatments they need.
In addition to securing the services an individual needs, a Reno health insurance lawyer can investigate the case to determine whether or not the insurance company acted in bad faith with their denial or deliberately delayed or underpaid the claim. In such cases, the insured party or their guardian may be entitled to pursue damages.
