Mental / Behavioral Health and Insurance

Mental Health Parity Report

Both federal and Colorado state law provide protections for consumers accessing mental and behavioral health services. The following information provides an overview for consumers and providers on mental health parity law.  Parity laws prohibit health plans from being more restrictive with mental health, behavioral health, and substance use disorder benefits than the medical and surgical benefits the plans offer. Colorado state law requires that health insurance companies cover services for mental and behavioral health conditions the same way they cover other medical conditions, like diabetes or heart disease. This is called “parity" and it's about equal and fair treatment for people who need mental and behavioral health care.

2020 Division of Insurance Mental Health Parity Report

COVID-19, Telehealth and Mental / Behavioral Health

On April 3, 2020, the Division of Insurance adopted Emergency Regulation 20-E-05 - Concerning Coverage and Reimbursement for Telehealth Services During the COVID-19 Emergency

This regulation addresses many aspects of telehealth, and specifically calls out mental / behavioral health: "Telehealth services delivered by providers shall be reimbursed at rates not lower than in-person services delivered by providers and in compliance with state behavioral health parity laws." 

 

 

FAQs on COVID-19 Telehealth Services

Federal and Colorado State law requires that health insurance carriers cover services for mental and behavioral health conditions the same way they cover other medical conditions, like diabetes or heart disease. This is called “parity.” Parity is about equal and fair treatment for people who need mental and behavioral health care.

Parity laws prohibit health insurance plans from being more restrictive in providing mental health, behavioral health, and substance use disorder benefits than they would be for medical and surgical benefits, with respect to the following.

  • What you pay: Copays, coinsurance, deductibles, and out-of-pocket maximums (collectively referred to as cost-sharing)
  • How much treatment you can get: Limitations on the use of services, such as limits on the number of inpatient or outpatient visits that are covered
  • Use of management tools: Such as pre-authorization requirements
  • Which doctors you can see: Adequate providers in-network to provide necessary services, coverage for out-of-network providers, and considerations for geographic location
  • Determining criteria: This is what the insurance company uses to determine what is considered medically necessary treatment.

“Mental Health” vs. “Behavioral Health” - Mental health and behavioral health are sometimes used interchangeably, but they’re not quite the same. Mental health refers to a person’s psychological and/or emotional well-being, whereas behavioral health is an umbrella term that includes a variety of factors that impact a person’s well-being, development, and behavior. This includes, but is not limited to, mental health conditions, substance use disorders, eating habits, and external factors that influence a person’s well-being, like poverty, housing insecurity, and trauma. 

 

In many cases, yes. There are only a few exceptions of health plans that DO NOT have to follow Federal parity laws: 

  • Most of Medicare does not have to follow parity laws (the exceptions are Medicare's outpatient mental health services cost-sharing - what you, the consumer has to pay - and Medicare Advantage plans: both have to follow parity laws)
  • Health plans that were created and purchased before March 23, 2010, do not have to follow parity laws. These are called “grandfathered” plans, as they were allowed to continue after the Affordable Care Act became law in 2010, or “grandfathered” under the old rules. These could be employer plans or individual (non-employer) plans. 

All other types of health insurance plans must follow State and Federal parity laws. These include employer plans (both large and small employer plans), individual plans (meaning not from an employer), student health plans, Colorado Medicaid (known as Health First Colorado) and Child Health Plan Plus (CHP+). 

If you are unsure about what type of plan you have, ask your insurance company or agent, your plan administrator, your employer (specifically your human resources department), or the Division of Insurance - 303-894-7490 / 800-930-3745 / DORA_Insurance@state.co.us

Additional Protections - Does your health insurance card say “CO-DOI” on it?

If so, your plan is regulated by the Colorado Division of Insurance and has additional enforcement protections for parity as well as federal protections.

If your plan is not regulated by the Division of Insurance, it may still have parity protections. Contact Colorado’s Behavioral Health Ombudsman of Colorado with questions, complaints, or support in seeking services. 

Contact the Colorado Division of Insurance if you are unsure about what kind of health insurance you have, its mental / behavioral health care coverage or need to ask questions or file a complaint - 303-894-7490 800-930-3745 / DORA_Insurance@state.co.us - or visit the Ask a Question / File a Complaint page of the DOI’s website.