Situation · mental health & substance use
They can't treat your mind worse than your body. That's the law.
The federal parity law (MHPAEA) requires that mental-health and substance-use coverage be no more restrictive than medical coverage — same logic for visit limits, prior authorization, "fail first" rules, and reimbursement. A mental-health denial that wouldn't have happened to a comparable medical claim is illegal.
Spotting a parity violation
- Therapy visit caps while physical therapy runs uncapped — suspect.
- Prior authorization for every therapy session but not for routine medical visits — suspect.
- "Not medically necessary" for residential or intensive outpatient care using stricter criteria than medical rehab — the most common violation.
- Appeal with the p-word. Cite the Mental Health Parity and Addiction Equity Act and demand the plan's comparative analysis — they're legally required to have one.
- Escalate hard. Parity complaints go to your state insurance commissioner, or the U.S. Department of Labor (1-866-444-3272) for employer plans. Regulators are actively hunting these.
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Start your appeal & set your clock →Common questions
- What is mental health parity?
- Federal law (MHPAEA) requiring insurance to cover mental-health and substance-use treatment no more restrictively than medical treatment — limits, authorizations, and criteria must be comparable.
- My insurer denied residential treatment as not medically necessary. Is that a parity issue?
- Often, yes. If the criteria used for mental-health residential care are stricter than for comparable medical care (like inpatient rehab), that's a classic parity violation — appeal citing MHPAEA and file a regulator complaint in parallel.