Parity Denial Appeal

Under the Mental Health Parity and Addiction Equity Act (29 U.S.C. § 1185a) and {{applicable_state_parity_law}}, this plan may not apply non-quantitative treatment limitations — such as restrictive medical-necessity criteria or specialized prior authorization — to behavioral-health benefits more stringently than to comparable medical/surgical benefits. The denial of {{service_name}} for {{patient_reference}} uses internal criteria more restrictive than generally recognized independent standards (e.g., {{independent_clinical_standard}}). This intervention is medically necessary given {{patient_symptoms}}. Pursuant to Section 203 of the Consolidated Appropriations Act of 2021, we formally request the written comparative analysis demonstrating that the evidentiary standards and methodologies used to apply this limitation are applied no more stringently to MH/SUD benefits than to comparable medical/surgical benefits.