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Appeal Letter: Mental Health Therapy Denied by Insurance

Use this template when your insurer denied mental health therapy or behavioral health treatment. Federal law (MHPAEA) requires insurers to cover mental health at parity with medical/surgical benefits.

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Key Arguments to Make

  • ✓The Mental Health Parity and Addiction Equity Act (MHPAEA) requires coverage of mental health services at parity with medical benefits
  • ✓Therapy is medically necessary as documented by a licensed mental health professional
  • ✓Denying therapy for a diagnosed mental health condition while covering analogous medical conditions violates parity
  • ✓Interrupting treatment poses documented risks including symptom relapse and crisis escalation

Appeal Letter Template

Customize the sections below with your personal details. Replace text in [brackets] with your information.

Sample Appeal Letter — Mental Health TherapyPersonalize This Letter →
To: [Insurance Company Name], Appeals Department
Re: Appeal of Claim Denial — [Your Name] — Member ID: [Member ID]
Date: [Today's Date]
Opening

I am writing to appeal the denial of coverage for mental health therapy sessions with [Provider Name]. The denial reference number is [Denial Reference]. This denial may violate federal mental health parity law.

Parity Argument

Under the Mental Health Parity and Addiction Equity Act (MHPAEA) and the ACA, group health plans must provide mental health and substance use disorder benefits no more restrictively than medical/surgical benefits. I request that you document how the criteria applied to this denial compare to criteria applied to analogous medical conditions.

Medical Necessity Statement

I have been diagnosed with [Diagnosis] by [Provider Name]. My treatment plan includes [frequency] sessions of [therapy type] as part of a structured treatment plan. My provider has documented that continued therapy is medically necessary to [clinical goals].

Closing

I request reversal of this denial and approval of continued therapy as prescribed. I also request a full parity analysis comparing the medical management standards applied to my mental health claim against those applied to analogous medical/surgical claims.

Sincerely,
[Your Name]
[Phone] · [Email]

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