California Mental Health Insurance Parity AB 88 CA Insurance Code §§10144.5.  Health and Safety Code§1374.72   was passed in 1999. 

We are not attorney’s but do our best to keep our website visitors informed of the law and Insurance Coverage’s.   

So, one must compare AB 88, with the

EOC Evidence of Coverage, which you have a right to receive prior to purchasing coverage and the

Essential Benefits under Health Care Reform, namely Mental Health.

Insurance Code §10144.5

(a) Every policy of disability (health) insurance that covers hospital, medical, or surgical expenses in this state* … shall provide coverage for the diagnosis and medically necessary treatment of severe mental illnesses of a person of any age, and of serious emotional disturbances of a child, … under the same terms and conditions applied to other medical conditions,

(b) These benefits shall include the following:

(1) Outpatient services.
(2) Inpatient hospital services.
(3) Partial hospital services.

(4) Prescription drugs, if the policy or contract includes     coverage for prescription drugs.

(c) The terms and conditions applied to the benefits required by this section that shall be applied equally to all benefits under the disability (Health, Medical)  insurance policy shall include, but not be limited to, the following:

(1) Maximum lifetime benefits.
(2) Co-payments and coinsurance.
(3) Individual and family deductibles.

   (d) For the purposes of this section, severe mental illnesses” shall include:

(1) Schizophrenia  schizophrenia.com/ WebMD
(2) Schizoaffective disorder. WedMD
(3) Bipolar disorder (manic-depressive illness). bipolar.com/ WebMD
(4) Major depressive disorders. WebMD
(5) Panic disorder. WebMD
(6) Obsessive-compulsive disorder. WebMD
(7) Pervasive developmental disorder WebMD  or autism. Web MD
(8) Anorexia nervosa. WebMD
(9) Bulimia nervosa. WebMD

   (e) For the purposes of this section, a child suffering from, “serious emotional disturbances of a child” shall be defined as a child who (1) has one or more mental disorders as identified in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders,  other than a primary substance use disorder or developmental disorder, that result in behavior inappropriate to the child’s age according to expected developmental norms, and … (g) This section shall not apply to accident-only, specified disease, hospital indemnity, Medicare supplement, dental-only, or vision-only insurance policies.  §10144.5.

Autism 7.1.2012 SB 946

Consumer Resources & Links

CA Dept. of Managed Health Care  on Mental Health Care

How long can your child stay on your Medical Insurance policy? AB 910

NAMI Guide to State Mental Health Parity Laws

NAMI on Parity

NAMI Walk A Thon Fund Raiser

Bazelon Center Paper on Health Reform & Mental Health

COBRA?

HIPAA?  Historical…

Medical Necessity

Blue Cross Brochures – check the  Mental Health Section –

Individual & Family Plan Underwriting Criteria – –AB 88 applies to in force policies – it doesn’t require an Insurance Company to write you.

Grievances

Sample Requirements for Mental Health Services to be reimbursed by Insurance – Page 17

Sample Level of Care Assessment Tool

Sample Response to a website visitors questions.

Sample Research – Reviewing an Insurance Policy and if it would cover LONGER than 50 days in a Psychiatric Hospital.

Medical Insurance Issues?

Guaranteed INDIVIDUAL Medical Coverage – Mr. Mip

Do you belong to an Employer Group of 2 or more?

Employer Group with just ONE employee or owner?

health.discovery.com/tv/psych-week/

Government Sponsored Plans

Instant Complementary Health Insurance Proposals, Quotes, Subsidy Calculation and ONLINE Enrollment

 

Insure Buy International Medical Coverage

InsuBuy International Medical Coverage – Instant Quotes & Enrollment

Child Pages in the Mental Health Section 

Technical Links

Department of Managed Health Care
Compliance Surveys

Snapshot on Implementation of AB 88 CA Mental Health Parity Law
California Health Care Foundation

 

* Geographic Location of beneficiaries

California mental health care parity law, requiring health insurance policies to cover treatment for mental illness on same terms and conditions applied to other medical conditions, applied to health plan beneficiary who did not live in or seek medical care in California, even assuming that parity law applied to policies written to cover expenses incurred in California, inasmuch as plan was written to provide benefits to California beneficiaries, and did not limit its application on basis of where individual beneficiaries lived or sought medical care. Thompkins v. BC Life and Health Ins. Co., C.D.Cal.2006, 414 F.Supp.2d 953

Summary: This bill prohibits health plans from basing medical necessity denials on whether the admission for mental health services was voluntary or involuntary, or on the method of transportation of the patient to the health facility. This bill also requires plans that offer mental health services to have information on their website that will assist enrollees in accessing mental health services.  SB 1553  §1368.015, §1367.015Health & Safety Code

Blue Cross / Anthem Mental Health Procedures

How to Obtain Behavioral Health Services

You do not need a referral to see a behavioral health specialist. You may self-refer to a specialist in Anthem Blue Cross’ Behavioral Health network. Please confirm that the specialist is a participating provider at the time and location of service. For more information regarding mental health or chemical dependency services, please refer to the behavioral health disclaimer section in the Provider Finder section of Anthem Blue Cross’ website Member Access.
Outpatient professional mental health or chemical dependency services do not require an authorization or referral from your primary care physician (PCP) or medical group/IPA. Your PCP, however, may be able to recommend the appropriate type of provider for your needs.
In order to receive benefits under your HMO plan, you must access mental health or chemical dependency services from an Anthem Blue Cross (Blue Cross) Behavioral Health network provider. Please contact the provider directly to verify participation in the network and confirm that he/she is accepting new patients.
For behavioral health provider groups, please note that each individual professional in the group may not be listed on Provider Finder. Please call the group directly to verify those professionals participating in Anthem Blue Cross’ Behavioral Health network.   (anthem.com)

 

 

the Insurance Gender Nondiscrimination Act (IGNA), also known as AB 1586, prohibits health plans from denying medically necessary health care to transgender individuals insure me kevin.com

FSP – Full Service Partnership  dmh.lacounty.gov

Laura’s Law – Involuntary Treatment of Mentally Ill passes in LA County  latimes.com/    en.wikipedia.org

California Court of Appeals issued its decision in Marissa Rea v. Blue Shield of California.

The Court held that the California Mental Health Parity Act requires Blue Shield to provide medically necessary treatment for people suffering from severe mental illnesses, including anorexia and bulimia.

The case involved Blue Shield’s denial of residential treatment for the plaintiffs’ eating disorders.

Blue Shield argued that all the Parity Act required was equality of treatment between mental and physical illnesses and, since its policy did not cover residential treatment for physical illnesses, it did not have to provide residential treatment for severe mental illnesses. “This decision confirms that residential treatment is one of the most effective treatments for eating disorders, and must be available to California insureds who need this treatment,”  kantor  law.net

 

Historical Info

 

Please note though that this law only requires that if you ALREADY have coverage, it must provide equal benefits.  The law doesn’t require that an Individual Plan take someone with these underwriting issues.  If you’re eligible under an Employer Group plan, that would generally be guaranteed issue.  You might also check HIPAA, COBRA,Mr. Mip  and our Guaranteed Issue Page.

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