Your request for mental health treatment coverage was denied by your health insurance carrier.
Now what?
We asked representatives from state and federal agencies that regulate health insurers, along with representatives of the insurance industry, to give us a few pointers on what people should do next.
You can file an appeal that might lead your health insurer to reverse its decision, and if that fails, you can ask a government agency to review your case and potentially overrule the insurer.
Two different departments in California regulate health insurance carriers: the Department of Managed Health Care and the Department of Insurance. Some health plans are not regulated by the state, but instead by the federal Employee Benefits Security Administration of the U.S. Department of Labor.
Coverage requirements can be different. Plans regulated by the federal government don’t have to adhere to California’s most recent mental health coverage law.
In most cases you first need to file an internal appeal with your health insurance carrier. If you can’t figure out how to do so, the Department of Insurance recommends using a “Control-F” search online to look through your evidence of coverage for the word “complaint” or “complaints.”
In some cases, you can skip the internal appeal and instead go right to the Department of Managed Health Care. That’s possible when there’s an immediate threat to your health, or if you were denied authorization because you were seeking an experimental treatment. The Department of Insurance does not require consumers to exhaust all internal appeals before reaching out for help.
If you have completed the internal appeals process with your health plan and are still denied treatment authorization, you don’t have to give…
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