It has been 13 years since Congress passed the Mental Health Parity and Addiction Equity Act, yet patients and providers continue to struggle to get insurance providers to pay for legally mandated coverage in cases of medically necessary. Four authors with personal, medical, legal and policy experience have written a great guide that includes a letter template with suggested text, as well as expert advice. The Journal of Psychiatric Practice can be accessed and downloaded for free here 1
In summary, how can clinicians help their patients beyond wishing them luck with their insurers? The guide and authors’ offer considerable experience with these issues from multiple perspectives. They strongly recommend that clinicians provide patients with a medical necessity letter.
Such a letter can be an essential tool in patients’ dealings with insurers, empowering patients to preempt or reverse insurance denials by reinforcing the basis of case-specific clinical decisions and establishing the clinician’s assessment of the treatment as “medically necessary.” 2