Federal parity rules require a plan that covers mental health and substance use care to apply limits no stricter than those it uses for medical and surgical care. This reaches cost-sharing, visit limits, and access standards.
Ask your plan for its medical-necessity criteria, the reason for any denial, and its comparative analysis of treatment limits. If they show stricter rules for mental health care, you can appeal and file a complaint with the U.S. Department of Labor.
For most people, yes. Marketplace and other individual and small-group plans must cover mental health and substance use treatment as an essential health benefit; large-employer plans usually do but are not required to.
If your plan covers out-of-network medical care, parity requires it to cover out-of-network mental health and substance use care on comparable terms. It does not force a plan with no out-of-network medical benefits to add them.
The Mental Health Parity and Addiction Equity Act requires group health plans that cover mental health and substance-use treatment to do so on terms no more restrictive than for medical and surgical care, including copays, visit limits, and prior-authorization rules.