The law says we have a right to mental health parity, so why are people still struggling to get mental health care? That is the critical question NoHLA and other health care advocates keep asking. Despite the protections in the Mental Health Parity and Addiction Equity Act (MHPAEA) and the Affordable Care Act (ACA) that were supposed to make mental health benefits equal to medical benefits, the truth is that there are still significant barriers for those trying to access mental health care, including excessive preauthorization requirements, inadequate coverage, limited provider networks, higher out-of-pocket costs, and inappropriate exclusions. More than a decade after parity laws went into effect, patients still face an uphill battle getting mental health care. 

Now NoHLA is supporting Washington patients’ rights to sue their insurance companies for failing to provide mental health parity as required by their insurance contract. We authored an amicus “friend of the court” brief in a key mental health parity case that will be heard by Washington’s Supreme Court this fall, P.E.L. v. Premera Blue Cross. The case involves a minor child who sued Premera, Washington’s largest insurer for denying a residential mental health therapy she sought, with no consideration of her medical condition. Yet Premera argues that court challenges based on the contract’s parity requirement should not be permitted in this situation. If Premera wins, more than 244,000 Washingtonians who buy health insurance through the individual insurance market could lose their right to sue when their mental health parity rights are violated. Our amicus brief in this significant case was joined by the National Health Law Program, the Center for Health Law and Policy Innovation of Harvard Law School, and other organizations supporting access to mental and behavioral health treatment signed on to our brief. 

Premera is arguing that the plaintiff does not have the right to bring a lawsuit in state court because it is not expressly articulated in federal law. NoHLA and other mental health parity experts disagree, based on the history of insurance law. We also point out that the lack of providers and long wait times are evidence that parity does not yet exist in Washington state despite the legal mandate, and the availability of court review can motivate insurers to address the inadequacies that remain. 

The Washington Office of the Insurance Commissioner (OIC) also filed a “friend of the court” brief outlining why the decision in Premera’s favor would inappropriately shift enforcement to the federal government and create a more complex and expensive regulatory environment for insurers and consumers.

There has been a lot of attention on this issue of late, including:

• proposed regulations from the Departments of Labor, Health and Human Services, and Treasury; 
• new guidance from the OIC assisting Washingtonians in understand their behavioral health coverage rights, what to do if treatment is denied, how to get help, and the rules and limits on providers; and
• a Seattle Times article that includes observations from our own Janet Varon.

We will keep you apprised of these efforts.