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Both federal and Colorado state law provide protections for consumers accessing mental and behavioral health services. The following information provides an overview for consumers and providers on mental health parity law. Parity laws prohibit health plans from being more restrictive with mental health, behavioral health, and substance use disorder benefits than the medical and surgical benefits the plans offer. Colorado state law requires that health insurance companies cover services for mental and behavioral health conditions the same way they cover other medical conditions, like diabetes or heart disease. This is called “parity" and it's about equal and fair treatment for people who need mental and behavioral health care.
COVID-19, Telehealth and Mental / Behavioral Health - On April 3, 2020, the Division of Insurance adopted Emergency Regulation 20-E-05 - Concerning Coverage and Reimbursement for Telehealth Services During the COVID-19 Emergency. This regulation addresses many aspects of telehealth, and specifically calls out mental / behavioral health: "Telehealth services delivered by providers shall be reimbursed at rates not lower than in-person services delivered by providers and in compliance with state behavioral health parity laws." Please also see the Division's "FAQs on COVID-19 Telehealth Services" for more information.
Federal and Colorado State law requires that health insurance carriers cover services for mental and behavioral health conditions the same way they cover other medical conditions, like diabetes or heart disease. This is called “parity.” Parity is about equal and fair treatment for people who need mental and behavioral health care.
Parity laws prohibit health insurance plans from being more restrictive in providing mental health, behavioral health, and substance use disorder benefits than they would be for medical and surgical benefits, with respect to the following.
“Mental Health” vs. “Behavioral Health” - Mental health and behavioral health are sometimes used interchangeably, but they’re not quite the same. Mental health refers to a person’s psychological and/or emotional well-being, whereas behavioral health is an umbrella term that includes a variety of factors that impact a person’s well-being, development, and behavior. This includes, but is not limited to, mental health conditions, substance use disorders, eating habits, and external factors that influence a person’s well-being, like poverty, housing insecurity, and trauma.
In many cases, yes. There are only a few exceptions of health plans that DO NOT have to follow Federal parity laws:
All other types of health insurance plans must follow State and Federal parity laws. These include employer plans (both large and small employer plans), individual plans (meaning not from an employer), student health plans, Colorado Medicaid (known as Health First Colorado) and Child Health Plan Plus (CHP+).
If you are unsure about what type of plan you have, ask your insurance company or agent, your plan administrator, your employer (specifically your human resources department), or the Division of Insurance - 303-894-7490 / 800-930-3745 / DORA_Insurance@state.co.us.
Additional Protections - Does your health insurance card say “CO-DOI” on it?
If so, your plan is regulated by the Colorado Division of Insurance and has additional enforcement protections for parity as well as federal protections.
If your plan is not regulated by the Division of Insurance, it may still have parity protections. Contact Colorado’s Behavioral Health Ombudsman of Colorado with questions, complaints, or support in seeking services.
Contact the Colorado Division of Insurance if you are unsure about what kind of health insurance you have, its mental / behavioral health care coverage or need to ask questions or file a complaint - 303-894-7490 / 800-930-3745 / DORA_Insurance@state.co.us - or visit the Ask a Question / File a Complaint page of the DOI’s website.
Both federal and Colorado state law provide protections for consumers accessing mental / behavioral health services.
While it should be no harder or more expensive to get behavioral health treatment than physical health treatment, it can be hard to identify parity violations or know if you’re being unfairly denied coverage. The following examples, created by the Colorado Center on Law and Policy (CCLP), may indicate a violation of your behavioral health protections. The CCLP also offers this Fact Sheet on Parity Red Flags.
In addition to the information below, you can also look to this resource from the Colorado Center on Law and Policy (CCLP) that offers guidance on what you can do - Fact Sheet on Identifying Parity Act violations.
If you are experiencing a crisis, please call 911 or Colorado Crisis Services. Call 1-844-493-8255, text TALK to 38255, or access their chat function at coloradocrisisservices.org.
Behavioral Health Ombudsman of Colorado
Health First Colorado (Colorado Medicaid) and CHP+ Medicaid
The Trevor Project
Behavioral Health Task Force
FAQ About Mental Health and Substance Use Disorder Parity Implementation
Colorado Consumer Health Initiative (CCHI)
The Kennedy Forum