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New York State Residents Encouraged To Call Attorney General’s Health Care Helpline For Assistance Obtaining Treatment

Helpline Aims To Hold Health Insurers To Legal Obligation To Provide Necessary Medical Care

NEW YORK – Attorney General Eric T. Schneiderman today announced that his office is offering assistance for individuals and families seeking substance abuse and/or 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 today issued 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 from Attorney General Schneiderman aims to assist New York 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. Today’s 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.

“If your health plan denies the treatment your provider recommends, remember, you have rights under New York State law,” said Avi Israel, President of the addiction recovery non-profit Save the Michaels of the World. “Your loved one shouldn’t have to ‘fail first’ and you have the right to appeal the plan’s denial. Don’t simply take no for an answer and walk away. Call Attorney General Eric Schneiderman’s Health Care Helpline and ask for help.”

“The radical transformation of the health care system has rendered people sometimes confused by the laws designed to improve access and quality of care for the people it serves,” said Jeremy Klemanski, President & CEO, Syracuse Behavioral Healthcare. “The Attorney General’s Helpline is a tremendous resource to help any of us verify the correctness of how our insurance is, or is not working to provide the care we are paying our premiums for. The average person may not have an attorney on speed dial, but every New Yorker has the Attorney Generals legal team on speed dial by calling the Health Care Bureau Helpline.”

“NCADD-RA supports the NYS Attorney General’s health insurance know-your-rights alert and supports the full implementation of NY’s parity law (Timothy’s Law),” said Jennifer Faringer, Director, DePaul’s National Council on Alcoholism and Drug Dependence – Rochester Area. “Until both substance use disorders and mental health disorders are regarded the same, viewed without stigma, and treated on par with coverage equal to that of any other disease, we will have not achieved true parity in NYS. We join the AG in encouraging individuals and their families to contact the AG Health Care Helpline with any questions.”

“Horizon is committed to providing necessary education and resources to our community on how best to navigate treatment services for patients and their families struggling with substance use and mental health disorders,” said Anne D. Constantino, President & CEO, Horizon Health Services. “We appreciate the efforts of the Attorney General’s office in bringing these issues to the attention of our community members, providing resources and assisting those members amongst this epidemic.”

“If our society is ever to stop the proliferation of opiate drug addiction, then it must make a commitment to treat the many addicts in dire need of help,” said John Socci, Board Member of HEAL of Cayuga County. “Our organization has seen many addicts denied treatment coverage and we believe under the law, health insurance companies have an obligation to provide such coverage.”

“We have an opportunity to save a life by providing treatment to those suffering with addiction,” said Monika Taylor, LCSW, CASAC Director at Crouse Hospital Chemical Dependency Treatment Services. “The helpline assists these individuals and their families navigate through the difficult process of getting treatment through their health insurance companies.”

“Drug Crisis in our Backyard is in full support of the Attorney General’s initiative to bring awareness of the mental health parity act,” said Susan Salomone, Executive Director of Drug Crisis in our Backyard. “Because of the stigma associated with this disease, those suffering do not know where to turn for help. The AG’s helpline is an important resource for people trying to access critical information regarding insurance coverage.”

“As we continue to address this unprecedented health crisis, removing barriers to addiction treatment is absolutely critical and for families that often means doing battle with both a relentless disease and with their insurance company,” said Jeffrey L. Reynolds, President & CEO, Family and Children’s Association. “We are fortunate to have an Attorney General in Eric Schneiderman who is working to remove barriers to care and continues to be a champion for New York’s families in need.”

“The Long Island Council on Alcoholism and Drug Dependence (LICADD) commends Attorney General Schneiderman for his continued care and concern for New York families struggling with substance use disorders,” said Steven Chassman, Executive Director, The Long Island Council on Alcoholism and Drug Dependence (LICADD). “In order to turn the corner on this devastating public health crisis that is taking the lives of too many New Yorkers, access to quality and affordable treatment is essential. It has been entirely too common and tragic that individuals are denied access to quality treatment based on cost saving models by insurance companies. As a result, the substance use crisis has only progressed to horrific levels of loss and destruction for thousands of New York families. An individual’s ability to access his/her insurance benefits and to be granted the opportunity to receive quality treatment, should be considered a basic right that should not be denied. LICADD offers gratitude and appreciation to Attorney General Schneiderman on behalf of the thousands of individuals we see each year who are denied access to quality treatment for substance use disorders.”

“We commend Attorney General Schneiderman for his tireless efforts in support and enforcement of Timothy’s Law (Mental Health Parity),” said Glenn Liebman, CEO of the Mental Health Association of NYS. “There has been a great deal of nationwide confusion about  the scope of mental health parity and the impact to families and individuals with mental health concerns. The Attorney General and his staff have contributed to helping to create an environment in New York that is pro-active and responsive to the needs of those impacted by mental illness. To that end, we strongly support the Attorney General’s  initiative to provide education and public awareness to the hundreds of thousands of New Yorkers who have a co-occurring mental illness and substance abuse issue.”

Consumers with questions or concerns about rights for those seeking drug abuse treatment or other health care matters may call the Attorney General’s Health Care Bureau Helpline at 1-800-428-9071.


Posted by Ambi Daniel