PENNSYLVANIA — Pennsylvania Insurance Commissioner Michael Humphreys announced the Pennsylvania Insurance Department (PID) has updated its resources available for consumers to learn about mental health and substance use disorder coverage parity and their benefits and rights under the law. Commissioner Humphreys is encouraging consumers to explore the resources the department has available, and to file a complaint with the department if they believe they are not receiving the proper coverage.
“The Shapiro Administration has made clear that insurers will be held accountable for mental health and substance use disorder parity violations, and to that end, the Insurance Department seeks to be a resource for consumers who experience coverage issues,” said Humphreys. “We are working to create materials that educate consumers on what a violation might look like, and to assist individuals through the complaint process.”
The updated resources include a new web page designed to help guide consumers to their coverage options, as well as new outreach materials that will help consumers spot red flags in their health plan’s coverage of mental health substance use disorder treatment.
The new parity website can be accessed at www.insurance.pa.gov/parity. There, consumers will find information on what parity is, what their type of health insurance plan is required to cover, videos, FAQs, and resources to contact if they have a question, need to file a complaint, or need to get coverage.
New outreach materials, also available at www.insurance.pa.gov/parity, aim to educate consumers on what a parity violation may look like, and the questions they should be asking their insurer when they encounter a coverage issue. These materials are available for both mental health and substance use disorder treatment. The department plans to distribute these materials to provider offices Commonwealth-wide, to reach a broad audience of individuals who may be experiencing parity violations.
A consumer who thinks their health plan is not meeting parity requirements is encouraged to contact the Department to file a complaint. The Department’s Bureau of Consumer Services is available to assist with questions or complaints against an insurance company or an insurance producer (agent/broker).
Complaints can be filed online at the Pennsylvania Consumer Services Online (CSO) Portal, a fast and secure online customer service tool that requires initial registration. Following submission of a complaint, the filer will receive an email notification indicating that the complaint was successfully submitted, with a Department file number, the name of the investigator assigned, and contact information. Consumers can also update or add information, upload new documents, track the status of their complaint with the PID file number, and communicate with PID staff via email in the CSO Portal.
Complaints can also be filed by calling Consumer Services and requesting a complaint form and mailing or faxing the submission. The Department also recently added the option for an advocate to file a complaint on behalf of a consumer.
As Pennsylvania law provides insurers with 15 working days to respond to a PID inquiry, complaints are typically concluded 45-60 days from the date of receipt. However, PID staff strives for 30 days to complete a complaint investigation.
“It is important that consumers understand the rights and benefits to which they are entitled under parity law and know that the Insurance Department is available when insurers are coming up short on providing those benefits,” said Humphreys. “We’re putting Pennsylvania insurance companies on notice that we expect parity requirements to be followed, and letting consumers know that they can come to us when that doesn’t happen. PID is intent on being a productive force for good when it comes to handling parity violations.”
For more information on mental health and substance use disorder coverage parity, visit www.insurance.pa.gov/parity.
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