Struggling to Get Coverage for Therapy, Inpatient Care, or Counseling?

Advocating for Your Mental Well-Being

Mental health is just as vital as physical health, with untreated mental health issues carrying serious consequences, including the alarming statistic of suicide ranking as the tenth leading cause of death in the United States.

Yet, insurance companies routinely deny mental health insurance claims, leaving many individuals unaware of their rights and reluctant to challenge these denials. However, there is a framework of regulations governing the health insurance industry that may empower you to take action if your claim has been unjustly denied. In San Francisco, you may be able to assert your rights and access the care you genuinely deserve.

California’s Mental Health Parity Act - Bridging the Gap

Under the California Health & Safety Code, health insurance companies in San Jose and surrounding communities are legally bound not to restrict mental health care options more than they limit physical health claims. This regulation extends to all facets of treatment, covering diagnoses, medications, inpatient and outpatient care, and more.

Insurance companies subject to this law are required to provide treatment for a wide range of mental health issues, including but not limited to bipolar disorder, anorexia, bulimia, obsessive-compulsive disorder, depressive disorders, and various other mental health conditions. It's crucial to recognize that this legal safeguard applies to state-regulated health care plans, while Medicare, VA programs, self-funded plans, and Medi-Cal fall outside its purview. Nonetheless, these exclusions do not give insurers free rein to deny mental health insurance claims without due cause. Many insurance plans in the Bay Area are governed by federal parity laws.

What to Do After a Denied Claim - Protecting Your Rights

When you receive notice of denied mental health insurance benefits, swift action is essential to safeguard your rights, establish a clear paper trail, and hold the insurance company accountable. Take the following steps after a claim is denied:

• Document Claim Details: Ensure you record essential information such as the claim number, care provider, date of service, date of denial, and the reason for the denial.
• Review Plan Paperwork: Keep copies of your health insurance paperwork, which should outline the covered care and any specific exclusions.
• Consult a Mental Health Insurance Lawyer: You have the option to appeal the insurance company’s decision to deny your claim. However, it's important to understand that you'll be up against an industry with substantial resources that profits from denying claims. Collaborating with a mental health insurance lawyer who is well-versed in navigating the system minimizes your stress and enhances your chances of success.

Navigating the Appeals Process - Your Guide to Success

Insurance companies are legally obligated to provide information on the appeals process to subscribers. Yet, they often make this process convoluted and challenging to comprehend, leading many subscribers to abandon their claims prematurely. If your claim is denied, it's crucial to familiarize yourself with the appeals process.

Our extensive experience in working with both large and small insurance companies places us in an excellent position to assist you through the appeals process. You should be able to find information on the number of allowed appeals, required documentation, the availability of external appeals, and appeal deadlines in your initial enrollment paperwork and on the insurer's website. Sharing this information with your health care insurance attorney streamlines the process.

Fighting for Your Right to Mental Health Care - Your Premiums, Your Care

You pay your health insurance premiums with the expectation that the insurance company will fulfill its obligations. It is only fair that they do so. Until the systemic issue of mental health care claim denials is resolved (these denials are reportedly twice as common as denials for general medical care claims), it's imperative to stand up for your individual right to mental health care.

How We Can Assist With Denied Mental Health Insurance Benefits

At DL Law Group, we are steadfast advocates for consumer rights. Health insurance companies bear the responsibility to adhere to the terms of their policies and provide consumers with the care for which they pay their monthly premiums. When they fall short in fulfilling their obligations, we are prepared to hold them accountable. Our approach encompasses various techniques, including:

• Examining Parity Law Compliance: If your insurer demonstrates a stricter stance on mental health claims than physical health claims, it may be in violation of state or federal laws.
• Leveraging Current Evidence: Insurance companies generally favor evidence-based care. We utilize our extensive knowledge of current research to demonstrate that the care you sought is evidence-based and should be covered by insurance.
• Establishing Medical Necessity: Our team works diligently to prove that the care you received was medically necessary. We may draw upon your statements, those of your care providers, or diagnostic criteria to establish that your care enhances your quality of life.

If you're grappling with mental health challenges, battling insurance companies can intensify your stress and impede your healing journey. Let us be your guiding light. Initiate the process by reaching out to DL Law Group at 415-678-5050. We are ready to assist you.