What are the specific steps to access mental health or substance use disorder treatment under California's mental health parity laws?

To access mental health or substance use disorder care, you must use your health plan's process, but California law ensures your insurer cannot unfairly limit or deny medically necessary treatment. The key is to find a provider, get a treatment recommendation, and appeal any denial of care. Here are the specific steps to access your benefits: Step 1: Find a Provider Check your health plan’s provider directory online or call the member services number on your insurance card for a list of in-network therapists, psychiatrists, or treatment facilities. Your plan must help you find an available provider. Step 2: Schedule an Appointment Under California's timely access laws, you must be offered an appointment with a non-physician mental health provider within 10 business days of your request. For an urgent appointment not requiring prior authorization, it must be offered within 48 hours. Step 3: Obtain a Treatment Recommendation Your provider will assess your condition and recommend a course of treatment. Under California law, if your provider determines a treatment is "medically necessary" based on generally accepted standards of care, your health plan is required to cover it. Step 4: Request Authorization from Your Insurer (If Required) For some services, like intensive outpatient or residential treatment, your provider may need to request prior authorization from your insurer. They will submit clinical information to show the treatment is medically necessary. Step 5: Appeal if Your Request is Denied If your insurer denies coverage, you have the right to appeal. First, file an internal appeal directly with your health plan. If they still deny coverage, you can file a complaint and request an Independent Medical Review (IMR) with your regulator—either the Department of Managed Health Care (DMHC) or the Department of Insurance (CDI). Important Details and Nuances: California's parity law (SB 855) requires health plans to cover medically necessary treatment for all mental health and substance use disorders listed in the DSM-5. They cannot limit benefits to short-term or crisis care and must use clinical criteria developed by nonprofit professional associations. Warnings and Limitations: Always keep detailed notes of your conversations with your health plan, including the date, time, and name of the person you spoke with. Strictly follow all deadlines for filing appeals, as missing them can cause you to lose your rights. This is general information and does not constitute legal advice. For complex situations, consult with a qualified California attorney.