Federal and New York State laws forbid health insurers from discriminating against people with substance use or mental disorders. These laws are called “parity laws.” For an explanation of patients’ and health care providers’ rights under parity laws, please refer to Health Insurance for Addiction & Mental Health Care: A Guide to the Federal Parity Law.
If you think a health insurer is violating your rights under the parity laws, there are several steps you can take, including filing appeals and complaints. Complaints also help regulators find out if a health plan is violating the parity laws. The Legal Action Center has drafted several sample appeals, complaints, and other letters for both patients and providers who think their rights under the parity law may have been violated. These samples can also be adapted for use by advocates, family members, and others. Choose the appropriate sample from the list below, download it, and modify it for your situation. When text is gray and bracketed, you need to modify it or, in some cases, decide whether to include it based on your individual circumstances. For a full explanation of how to enforce your rights under the parity laws, see Chapter 7 of Health Insurance for Addiction & Mental Health Care: A Guide to the Federal Parity Law.
For every appeal, complaint or letter:
- Patients and health care providers should coordinate about who is filing appeals.
- Make copies of everything, and keep them in a safe place.
- Call Community Health Advocates at 1-888-614-5400 if you need help.
Internal Appeal Letters
- Sample Patient Internal Appeal (Parity)
- Sample Provider Letter In Support of Patient Internal Appeal (Parity)
- Sample Provider Internal Appeal (Parity)
External Appeal Letters
Request Letters for Information/Documents
Complaint Letters to State Government Agencies
- Sample Patient Complaint to State Government Agency (Parity)
- Sample Provider Complaint to State Government Agency (Parity)
Complaint Letters to Federal Government Agencies