Parity in Name Only: Mental Health Access in 2025
Why your insurance might not treat mental health the same way it treats a broken bone, and what WE can do about it.
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Imagine this:
Your child breaks their arm. You call the pediatrician, get referred to an orthopedic specialist, and see them within days — all covered by your insurance.
Then, your child has a panic attack. You try to get them into therapy, only to discover the first available in-network appointment is three months away. If you want help sooner, you’ll need to pay out of pocket… assuming you can even find someone accepting new patients.
Mental health parity laws were designed to prevent that kind of disparity, but more than 15 years after they were passed, true parity is still more promise than reality.
What Is Mental Health Parity, Really?
The Mental Health Parity and Addiction Equity Act (MHPAEA) was signed into law in 2008. It requires that insurance plans offering mental health or substance use disorder (MH/SUD) benefits treat them the same as physical health benefits.
That means your plan shouldn’t:
Charge higher copays for therapy than for a medical specialist
Limit the number of therapy sessions without doing the same for physical rehab
Require more hoops (like prior authorizations) for antidepressants than antibiotics
In theory, mental health care is supposed to be equal, but in practice, patients often face very different (and inequitable) access.
Where the System Breaks Down
Even when plans technically comply with the law, they often fall short in real-world implementation. Here’s how:
Narrow networks: Patients struggle to find in-network therapists or psychiatrists with availability.
Out-of-pocket burdens: Even when care is covered, high deductibles and co-insurance make it unaffordable.
Prior authorizations: Mental health medications and therapies often face more pre-approval hurdles than physical health treatments.
“Ghost networks”: Directories list providers who no longer accept insurance or aren’t accepting new patients.
Real story: A rural mom emailed her insurance for an in-network child therapist. The list had 22 names. Only 3 returned her call. All 3 said they weren’t accepting new clients and hadn’t been for months.
Who Gets Left Behind?
Mental health parity problems aren’t evenly distributed.
Rural communities often have no local providers at all.
BIPOC patients face both fewer culturally competent providers and more systemic distrust.
LGBTQ+ youth, who are more likely to need care, are less likely to have access through their insurance.
Low-income families may be “covered” on paper but can’t afford the out-of-network costs when they can’t find in-network options.
This isn’t just a policy failure. It’s a health equity issue.
What Mental Health Providers Are Up Against
It’s not just patients feeling the impact. Many mental health professionals have opted out of insurance altogether- not because they don’t want to help, but because the system makes it unsustainable.
Reimbursement rates are often lower than for physical health services.
Insurance billing requires complex documentation and time-consuming appeals.
Solo or small practices may not have administrative support to handle it.
This pushes more therapists out-of-network and drives up costs for patients, creating a vicious cycle.
What Can Be Done?
Whether you’re a patient, provider, or somewhere in between, here are tangible steps you can take:
For Patients:
Know your rights: MHPAEA gives you legal grounds to challenge unfair limitations. Here’s a simple explainer from CMS.
Appeal coverage denials: You have the right to challenge insurance decisions, and insurers often reverse course if challenged. See my article on How to Submit an Appeal.
Report violations: File complaints with your state’s insurance commissioner or the Department of Labor (for employer-sponsored plans).
For Providers and Other Health Professionals:
Help patients understand parity and navigate appeals.
Keep documentation of any insurer patterns that suggest non-compliance.
Engage in local and state-level advocacy around network adequacy, reimbursement fairness, and transparency.
What’s Changing in 2025?
The federal government is increasing scrutiny of parity compliance:
The Biden administration issued proposed rules in 2023 to strengthen enforcement and close loopholes.
Plans will need to prove they don’t impose more restrictive non-quantitative treatment limits (like pre-authorization) for MH/SUD care.
States are starting to audit insurance companies and employer plans, with more transparency expected.
Enforcement is only as strong as the pressure behind it. We will see how coming policy changes will impact mental health parity.
Final Thoughts
Mental health parity is a right, not a favor, but rights only work if people know about them, advocate for them, and hold systems accountable.
If you're struggling to get mental health care or are tired of fighting your insurance, you're not alone. You're navigating a system that still treats the mind and body as separate, even when the law (and science) says otherwise.
Resources & Related Reading
The Chaos of Prior Authorizations
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Know Your Rights: How To File a Claim & Write an Appeals Letter to Your Health Insurance
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Hey there! If you’ve been enjoying this newsletter and finding value in the content, consider supporting my work by adding a paid subscription or donating through the Ko-Fi Link in my bio for coffee donations. Creating this takes time, research, and at least
When Help Never Comes: The Human Cost of a Broken System
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How to Find a Mental Healthcare Provider
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Hey there! If you’ve been enjoying this newsletter and finding value in the content, consider supporting my work by adding a paid subscription or donating through the Ko-Fi Link in my bio for coffee donations. Creating this takes time, research, and at least
What You Can Do Next:
Share this newsletter with someone navigating mental health care
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Until next time,
Caroline Waltzman
Your health Translator and Navigator, one newsletter at a time