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Your request for mental health treatment coverage has been denied by your health insurance carrier.

now what?

We asked representatives of state and federal agencies that regulate health insurance, along with representatives of the insurance industry, to give us some pointers on what people should do next.

You can file an appeal that could cause your health insurer to overturn its decision, and if that’s unsuccessful, you can ask a government agency to review your case and possibly overturn the insurer.

Two different departments in California regulate health insurance carriers: the Department of Managed Health Care and the Department of Insurance. Some health plans are not regulated by the state, but instead by the federal Employee Benefits Security Administration of the US Department of Labor.

Coverage requirements may vary. Plans regulated by the federal government do not have to adhere to California’s the latest mental health coverage law.

In most cases, you must first file an internal appeal with your health insurance carrier. If you can’t figure out how to do this, the Department of Insurance recommends using a “Control-F” online search to search through your evidence of coverage for the word “claim” or “claims.”

In some cases, you can skip the internal call and go directly to the Managed Care Department instead. This is possible when there is an immediate threat to your health or if you have been refused authorization because you are seeking an experimental treatment. The Department of Insurance does not require consumers to exhaust all internal calls before seeking help.

If you have completed the internal appeals process with your health plan and are still being denied treatment authorization, you do not have to give up. The next step is to request an independent medical examination. In these reviews, outside experts review cases for the state to determine whether a health insurance carrier rightfully denied treatment.

To find out which regulator to contact, try calling your health plan or looking for documents provided by your insurance carrier. And if you still can’t figure it out, you can contact one of the state departments – they say they will eventually get independent medical review applications in the right place.

To request an independent medical assessment at Department of Managed Healthcarewhich regulates most state plans, go to this website.

To request an independent medical assessment at California Department of Insurance, start from this site.

To contact Employee Benefits Security Administrationtry askEBSA.dol.gov or 1-866-444-3272

More information about the appeals process can be found on this website at US Centers for Medicare and Medicaid Services .

And on this site from Department of Labor.