Health Insurance: Behavioral Health Services - NYC Health

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Health Insurance: Behavioral Health Services

Many insurance plans offer mental health and addiction disorder benefits. In New York State, most insurance plans must follow laws that protect your right to access these behavioral health services and have them covered.

If your insurance plan is covered by those laws, then any behavioral health services they offer should be covered the same way as medical services. This is called behavioral health parity.

When insurance companies break the law, they make it harder for you to find, get and afford care for mental health and addiction disorders. If your insurance plan offers behavioral health benefits, it should not be more difficult to get your plan to cover behavioral health care than physical health care.

Equal Coverage

Most insurance plans in New York are required to cover treatment for mental health and substance use disorders. Plans that offer such coverage must cover treatment for behavioral health conditions equally — with similar copays, deductibles, and benefits — to treatment for physical health conditions.

This means the coverage for mental health and addiction disorders must be similar to what is offered for physical health conditions.

Some of the benefits that must be similar are:

Deductibles, copays and out-of-pocket maximum costs

The number of visits per year, days of treatment and other limits with a number

Needing approval before treatment and other limits without a number

In many cases, if your insurance plan denies you coverage of a mental health or addiction treatment or service, you can appeal the decision with your health plan or through an independent third party.

Parity Red Flags for Health Insurance Plan Members (PDF)

Get Help

For free and confidential help getting mental health or addiction services, contact the Community Health Access to Addiction and Mental Healthcare Project (CHAMP), which is the New York State independent health insurance ombudsman program.

CHAMP can help you:

Find a provider

Understand your insurance benefits

Assist you with coverage denials related to parity

Connect you to legal or social services

Contact CHAMP at 888-614-5400 or ombuds@oasas.ny.gov.

Additionally, some service providers, care managers, case managers and peer specialists also provide support and help you find resources.

Training for Community Members

The Health Department offers free virtual trainings to help anyone with health insurance learn more about access to behavioral health services. It will give you information on how behavioral health parity applies to your health insurance plan and your access to services. You will learn more about the law, how to identify violations and where to seek help if your rights are being denied.

The training, called "Behavioral Health Parity 101," takes 60 to 90 minutes. For more information, email BHParity@health.nyc.gov. See below to register for upcoming dates:

Friday, January 31, 10 a.m. to 11:15 a.m.

Training for Health Care Workers

The Health Department offers a free virtual training for people who provide services in health, behavioral health or social services. This includes mental health and substance use providers, primary care providers, hospital staff, social workers and child protective specialists, behavioral health peer specialists, community health workers and care managers.

The training, called "Behavioral Health Parity 101 for Service Providers," takes 60 to 90 minutes. Continuing education credits are available to satisfy LCSW and LMSW continuing education requirements, CASAC renewal and CPP/CPS credentialing requirements.For more information, email BHParity@health.nyc.gov. See below to register for upcoming dates:

Wednesday, January 10, 10:30 a.m. to 11:45 a.m.

Wednesday, February 12, 1 p.m. to 2:15 p.m.

Commercial Insurance Issues

For guidance on complying with laws related to commercial reimbursement and billing for OMH-licensed ambulatory programs, visit Commercial Billing for Behavioral Health Services

To file a complaint regarding behavioral health services billed under commercial insurance, go to https://www.dfs.ny.gov/complaint.

For questions regarding commercial billing for OMH-licensed School-Based Mental Health Clinic services, contact commercial-billing@omh.ny.gov.

Additional Resources

Legal Action Center

LAC provides education, support, and free legal services for people living in New York who have addiction disorders.

Community Service Society

CSS helps New Yorkers get, keep, and make better use of their health insurance.

New York State Office of the Attorney General Health Care Bureau

Call the Bureau’s toll-free Health Care Helpline at 800-428-9071 for information and assistance accessing and getting insurance coverage of health care.

Submit a complaint if you or a family member has had problems accessing emergency psychiatric care.

New York State Office of Mental Health Parity Enforcement

This state agency oversees and enforces parity laws in New York. You can file complaints, contact the agency with questions or learn more about the laws protecting your rights to behavioral health care coverage.

The Kennedy Forum

This national non-profit organization has developed educational resources and guides to educate consumers about their rights.

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