Mental Health Parity Appeal Letter Template

When to Use This Template

Use this letter when your insurer:

• Limits mental health visits but not comparable medical visits
• Requires prior authorization for therapy but not for comparable medical services
• Applies stricter medical necessity criteria to mental health
• Imposes higher copays or coinsurance for mental health services
• Denies residential mental health treatment while covering comparable medical inpatient stays

Template

[Your Name] [Your Address] [Date] [Insurance Company] Appeals Department [Address] Re: Mental Health Parity Appeal — [Claim/Reference Number] Member ID: [Your ID] Patient: [Name] | DOB: [Date]

Dear Appeals Review Committee,

I am writing to appeal the denial of [specific mental health service] under claim number [claim number], denied on [date]. This denial constitutes a violation of the Mental Health Parity and Addiction Equity Act (MHPAEA).

The Parity Violation:

[Plan name] covers [comparable medical/surgical service] without [the limitation applied to mental health service]. Applying [specific limitation] to mental health treatment while not applying the same limitation to analogous medical/surgical treatment is a quantitative/non-quantitative treatment limitation that violates MHPAEA.

Comparable Medical/Surgical Treatment:

Under this plan, [medical/surgical service] is covered with [no session limits / no prior authorization / lower cost-sharing]. The mental health service I am requesting — [specific service] — is an analogous treatment that should be subject to no greater limitations.

Clinical Justification:

[Treating provider] has determined that [specific service] is medically necessary for the treatment of [diagnosis]. [Include clinical details, treatment history, and expected outcomes.]

Requested Action:

I request that [plan name] immediately:

1. Approve coverage for [specific service] consistent with comparable medical/surgical benefits
2. Provide the comparative analysis required under MHPAEA upon request
3. Cease applying parity-violating limitations to mental health benefits

If this appeal is denied, I will file complaints with the Department of Labor/state insurance department regarding the parity violation.

Sincerely, [Your Name]

Key Points for Parity Letters

• Identify the SPECIFIC medical/surgical comparison (e.g., "PT visits are unlimited but therapy is capped at 20")
• Cite MHPAEA by name and reference 42 USC §§ 300gg-26
• Request the insurer's NQTL comparative analysis (they must provide it)