How Do Mental Health Parity Laws Impact “Usual, Customary and Reasonable”

Usual, Customary and Reasonable Benefit Adjustments are often ambiguously applied to out-of-network claims and providers are left with little understanding of if the benefit calculation is accurate or not.

While these balances are often the patient's responsibility, many healthcare providers take on the advocacy role by seeking clarification regarding the UCR calculation, appealing excessively large discounts and seeking input on what pricing database was used to calculate the benefit.  Read More. . . .

AppealTraining.com Featured Letters

The AppealLettersOnline.com appeal letter collection has two letters citing the Mental Health Parity and Addiction Equity Act (MHPAEA).

See the topic Specialty Care Appeal Review and the subtopic Mental/Nervous/Substance Abuse at AppealLettersOnline.com for the following new letters:

1. U.S. Mental Parity Lack of Auth
2. U.S. Mental Parity UCR