ALBANY, N.Y. (NEWS10) – Attorney General Eric Schneiderman has announced that his office is offering assistance for individuals and families seeking substance abuse and mental health treatment.

New York’s mental health parity law, known as Timothy’s Law, was enacted in 2006 and requires that insurers provide broad based coverage for the diagnosis and treatment of mental health disorders at least equal to coverage provided for other health conditions.

The New York Insurance Law also requires health plans to administer substance abuse treatment coverage consistent with the federal Mental Health Parity and Addiction Equity Act, which was enacted in 2008, and prohibits health plans from imposing greater financial requirements or treatment limitations on mental health or substance use disorder benefits than on medical or surgical benefits.

In order to help protect the rights of patients, Attorney General Schneiderman is issuing an alert encouraging those seeking treatment or facing barriers with their health insurer to call his office’s Health Care Helpline at 1-800-428-9071.

“Under the parity laws, health insurers are required to handle claims for mental health and addiction treatment services the same as medical claims,” said Attorney General Schneiderman. “My office has taken an aggressive approach to enforcing these laws and will continue to take on those who ignore the law and, by doing so, reinforce the false and painful stigma often associated with substance abuse and mental health conditions.”

The alert aims to assist residents and their families who are struggling with substance abuse or mental health disorders. According to the Centers for Disease Control (CDC), the number of drug overdoses related to opioid abuses have increased dramatically over the past decade, including over 2,000 drug overdose deaths in New York in 2014.

The alert aims to assist residents with knowing their rights when accessing substance abuse treatment through their insurance provider, and encourages them to contact the Attorney General’s Health Care Helpline with any questions.

New York State law mandates group health insurance plans cover inpatient and outpatient mental health and substance use disorder treatment (including detoxification and rehabilitation services) subject to plan review of medical necessity. Plans must conduct medical necessity review and calculate co-payments and co-insurance for mental health and substance use disorder benefits in a manner consistent with medical/surgical benefits.

Over the past two years, the Attorney General’s Health Care Bureau has signed agreements with five major companies (Cigna, MVP, EmblemHealth, ValueOptions/Beacon, and Excellus), representing millions of members across New York State, after determining that these companies were not in compliance with federal and state mental health parity laws. The Attorney General’s investigation found that the companies were improperly denying patients who were seeking mental health and substance abuse treatment. The settlements required the companies to implement a host of reforms to comply with state and federal law, and gave members the opportunity to appeal medical necessity denials. The Attorney General’s office also recovered $2.9 million in penalties, and secured $1.6 million in consumer reimbursements for out-of-pocket treatment costs. Since the agreements were signed, ongoing monitoring has for most plans shown fewer barriers to treatment, including lower denial rates and more consumers accessing needed care.

In addition, the Helpline has addressed numerous complaints about health plan coverage of mental health care, and has succeeded in many cases with obtaining approval of medically necessary care, or reimbursement where the consumer has paid for mental health care out-of-pocket.

Any resident who is denied substance abuse treatment should:

  • Check the denial letter for accuracy and inform plan of mistakes.
  • Ask the health provider to submit a letter of medical necessity, including facts that show that you meet the relevant medical necessity criteria, point-by-point.
  • Request a written, detailed explanation of the denial from the health insurance company.
  • Look for common improper denial flags, such as “fail first” requirements, reduced payments for out-of-network providers, insufficient or incorrect information in denial letters, refusing to provide medical necessity criteria or using criteria that do not match the health condition, and failure to consult with the health provider or consider medical evidence supplied.