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Mental health care denied? Federal law may protect you.
The Mental Health Parity and Addiction Equity Act (MHPAEA) requires most health plans to cover mental health and substance-use treatment on equal terms as physical health care. If your plan approves MRIs and ER visits without trouble but denies therapy, rehab, or medication for a mental health condition, your denial may violate federal law.
Upload the denial letter. Lysco checks for common parity violations, drafts an appeal with the right legal citations, and tells you exactly where to send it.
What parity actually means
Federal law requires most health plans to treat mental health and substance-use coverage the same way they treat physical health coverage. “The same way” covers three things:
- Cost. Your plan can’t charge higher copays, deductibles, or coinsurance for mental health care than it does for comparable medical care.
- Limits. The plan can’t impose stricter visit caps, day limits, or session counts on mental health care than it does on physical care.
- The fine print. The rules for getting approved — prior authorization, in-network requirements, medical-necessity criteria — can’t be tougher for mental health than for medical care. These are called “non-quantitative treatment limitations” (NQTLs), and the 2024 MHPAEA Final Rule gave regulators much sharper teeth on these.
Whether a specific denial violates parity depends on your plan’s actual rules, the comparable medical benefit, and how the plan applies its criteria. A regulator, court, or attorney makes that determination — not us.
Common mental health denials worth appealing
Outpatient therapy visit limits
Plans sometimes cap mental health therapy visits (e.g. 20/year) without imposing equivalent caps on physical therapy or chronic-condition check-ins. That can be a parity issue.
Residential / inpatient care denial
Residential eating-disorder, substance-use, or psychiatric treatment is often denied as "not medically necessary" under criteria that are stricter than what the plan uses for comparable medical inpatient care.
Medication management
Plans sometimes require step therapy on psychiatric medications without comparable step therapy on medications for other chronic conditions. The 2024 Final Rule specifically targets this.
Autism services (ABA, speech, OT)
Applied Behavior Analysis and related therapies for autism spectrum disorder are frequently denied or capped despite many state and federal parity protections.
Substance-use detox + rehab
Detox and rehab denials often cite criteria that don't exist for medical detox (e.g. cardiology). The 2024 Final Rule requires plans to prove their criteria are comparably applied.
Telehealth therapy
Some plans cover physical-health telehealth more generously than mental-health telehealth. That gap is exactly the kind of NQTL that parity law targets.
Who enforces parity — and what changed in 2024
Different agencies enforce MHPAEA depending on your plan type:
- U.S. Department of Labor (DOL) oversees employer-sponsored ERISA plans (most people with employer coverage).
- Centers for Medicare & Medicaid Services (CMS) oversees Medicaid, CHIP, and some individual-market plans.
- Your state’s insurance department oversees state-regulated individual, small-group, and non-ERISA plans.
The 2024 MHPAEA Final Rule (effective in stages through 2026) sharpened enforcement in several ways that matter for appeals: plans must now document that their criteria, prior-authorization rules, and network-adequacy practices don’t treat mental health worse than medical, and they must produce that documentation on request. If your plan can’t show comparable application, your denial may not survive scrutiny.
How Lysco helps with a parity appeal
Upload the denial letter
A photo, PDF, or the letter text. Lysco reads it in seconds and identifies the specific reason the plan gave.
Parity check
Lysco compares what the plan says against known parity issues and flags potentially non-compliant language — things like tougher prior-auth on therapy than on PT, or a medical-necessity standard that doesn't apply to physical health.
Draft the appeal
Lysco drafts an appeal letter that cites MHPAEA, the 2024 Final Rule, and (if applicable) your plan's own published criteria. You review, edit, and send.
Escalation if needed
If the internal appeal fails, Lysco helps you file an external review and — for ERISA plans — a DOL complaint or state insurance complaint.
Other help you should know about
Lysco handles the appeal letter. For clinical support, peer help, and direct advocacy, these organizations are the most trusted US resources:
- NAMI (National Alliance on Mental Illness) — free peer support, family resources, HelpLine 1-800-950-NAMI.
- Mental Health America — screenings, advocacy, state-level resources.
- U.S. Department of Labor — Mental Health Parity — official federal guidance and complaint pathways.
- The Kennedy Forum — Don’t Deny Me — advocacy-focused parity resources.
Start your appeal — free
Your first appeal letter is free. Takes 30 seconds to upload. No credit card needed.
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Important disclaimers. Lysco is a software tool — not a law firm, a medical provider, a mental health clinician, or a licensed patient advocate. Information on this page summarizes public statute and regulatory text and is intended as general information, not legal or medical advice. Whether a specific coverage decision violates the Mental Health Parity and Addiction Equity Act (MHPAEA), the 2024 Final Rule, ERISA, or any state parity law depends on the exact terms of your plan, how the plan applies its criteria, and other facts that may require review by a licensed attorney or a qualified parity expert. Lysco does not represent you in any administrative or judicial proceeding, does not guarantee any particular outcome, and does not submit letters on your behalf. For clinical concerns, please speak with a licensed mental health professional. If you are in crisis, call or text 988 for the Suicide & Crisis Lifeline.