Mental Health Appeal Help
Your Mental Health Treatment Was Denied Federal Parity Law Is On Your Side
The Mental Health Parity and Addiction Equity Act (MHPAEA) requires insurers to cover mental health and substance use treatment the same as medical care. If your insurer denied coverage, they may be breaking federal law.
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Quick Answer
Your mental health or substance abuse treatment was denied. Federal parity law (MHPAEA) requires equal coverage. ASAM and LOCUS criteria, and appeal strategies. AppealArmor drafts an appeal letter for this denial from your denial letter — free, no account required.
The federal parity law and your appeal
The Mental Health Parity and Addiction Equity Act (MHPAEA) is a federal consumer protection law. The law requires that health plans apply the same standards to mental health and substance use disorder benefits as they do to medical and surgical benefits.
This means if your plan does not require prior authorization for a medical hospital admission, it cannot require prior authorization for a psychiatric hospital admission. If your plan covers 60 physical therapy visits per year, it cannot limit you to 20 therapy sessions for mental health. If your plan covers residential rehabilitation for a physical injury, it must cover residential treatment for substance use disorders under comparable terms.
- - Employer-sponsored group health plans (ERISA and non-ERISA)
- - Individual marketplace plans (ACA)
- - Medicaid managed care plans
- - CHIP plans
- - Federal Employees Health Benefits (FEHB) plans
Note: Small group plans (fewer than 50 employees) that are self-insured may be exempt from some MHPAEA provisions.
Background Case: Wit v. United Behavioral Health
In 2019 a federal trial court found that United Behavioral Health (UBH, a subsidiary of UnitedHealthcare) used level-of-care guidelines that were more restrictive than generally accepted standards of care. In 2023 the Ninth Circuit reversed the class-wide reprocessing remedy, and its ruling turned on ERISA fiduciary duties and plan terms rather than on the parity law, so the case is background rather than binding precedent for your claim.
The 2019 trial ruling found that UBH's guidelines: failed to follow ASAM Criteria for substance use disorders, ignored the chronic nature of mental health conditions, prioritized acute stabilization over evidence-based treatment duration, and were developed with financial considerations rather than clinical evidence.
The practical lesson reaches beyond UBH: ask any insurer to apply generally accepted standards of care, including ASAM Criteria and LOCUS/CALOCUS, rather than stricter internal criteria. Ask your insurer which criteria it applied, and whether they follow these standards.
How AppealArmor Fights Your Mental Health Denial
Upload Your Denial Letter
Upload the denial notice. AppealArmor reads the service denied, the insurer's stated reason and your plan type, and you confirm every detail before anything is written.
We Find the Federal Rules for Your Plan
AppealArmor cites the federal appeal rules for your type of plan, plus state law where it applies from the eCFR. It does not run a parity analysis; you can ask your plan for its NQTL comparative analysis in writing.
Download Your Appeal Packet
Your packet is the appeal letter (Word and PDF) and a Next Steps sheet: where to send it, your deadline as your letter states it, who to copy, and who to contact if it is denied again. For employer plans the Next Steps sheet lists the Department of Labor's EBSA.
Frequently Asked Questions
What is the Mental Health Parity and Addiction Equity Act?
MHPAEA requires health plans to cover mental health and substance use disorder benefits at the same level as medical/surgical benefits. This applies to financial requirements (copays, deductibles) and treatment limitations (visit caps, prior auth requirements, network restrictions).
What is a Non-Quantitative Treatment Limitation (NQTL)?
NQTLs are non-numerical restrictions like prior authorization requirements, medical necessity criteria, step therapy requirements, and network adequacy standards. Under parity law, these restrictions cannot be more burdensome for mental health than for comparable medical conditions. For example, if surgical admissions do not require prior auth but psychiatric admissions do, that is a parity violation.
What was Wit v. United Behavioral Health?
In 2019 a federal trial court found that UBH (UnitedHealthcare's behavioral health subsidiary) used level-of-care guidelines more restrictive than generally accepted standards of care. In 2023 the Ninth Circuit reversed the class-wide order to reprocess denied claims, so the case is background rather than binding precedent. The useful argument it illustrates: ask your insurer to apply generally accepted standards such as ASAM Criteria and LOCUS.
My residential treatment was denied. Can I appeal?
Yes. Argue that the insurer's criteria are more restrictive than ASAM Criteria (for substance use) or LOCUS (for mental health). Also argue parity: if the plan covers inpatient rehabilitation for physical conditions, it must cover residential treatment for behavioral health under comparable terms. Request the insurer's NQTL analysis comparing residential mental health criteria to comparable medical inpatient criteria.
How do I request the insurer's NQTL comparative analysis?
Send a written request to your plan administrator citing MHPAEA Section 712(a)(8) and 29 CFR 2590.712(d). This analysis shows how the plan's mental health restrictions compare to medical/surgical restrictions. If the analysis shows disparate treatment, it is powerful evidence for both your appeal and a regulatory complaint.
Mental Health Treatment Deserves Equal Coverage. The Law Agrees.
Upload your mental health denial, check every detail we read from it, and AppealArmor drafts an appeal that answers the denial and cites the federal appeal rules for your plan, plus state law where it applies. Parity arguments (MHPAEA, ASAM Criteria, LOCUS) are yours to add.
Start my appealFree, always. No account. You review every word before you send it — and we never send anything to your insurer. You do.