Timothy’s Law and the Mental Health Parity Law in New York: Know Your Rights
Timothy O’clair, a 12-year-old boy from Schenectady, New York, took his own life in 2001. His short, tragic life was marked by years of mental health struggles. The O’clairs had worked relentlessly to get their son the necessary treatment, but repeatedly faced constraints from their insurance coverage. With mounting medical bills, financial difficulties, and limited coverage, getting help only grew harder and Timothy was unable to receive the care he needed. Following the tragic turn of events, Timothy’s parents became staunch advocates for parity, expanded mental health coverage, and equal access to mental healthcare.
In late 2006, the New York State Legislature passed “Timothy’s law”, a law that requires large group policies and insurance companies to provide mental health coverage similar to physical illnesses, thus creating parity in New York State. The law was made permanent in 2009, shortly after the enactment of the federal Mental Health Parity and Addiction Equity Act (MHPAEA).
Almost 14 years after its passage, insurance companies continue to violate the mental health parity law, often putting more restrictions on behavioral health benefits than other types of medical care.
Insurance Violations: Knowing and Recognizing Them
According to Paritytrack.org, if you’ve been denied coverage, your insurance company may be violating your rights. Other common violations include:
- Higher co-pays and other out-of-pocket expenses for mental health services than other physical health services.
- Having limits on the number of times you can see a mental healthcare provider.
- Having separate deductibles for mental health services that are not part of your overall deductible.
- Having limits on the number of days you can stay in a treatment facility.
- Insurance denying coverage for treatment outside your region or state.
- Getting charged more for mental health prescription medication than other physical health related medication.
Know Your Rights
Your benefits will depend on the type of coverage you have. Nonetheless, your plan should likely cover a minimum of 30 days of inpatient care and at least 20 outpatient visits per year for all mental health conditions. Read more here
If you feel your insurance may be violating your rights, or restricting your access to mental healthcare you can file an appeal at parityregistry.org.
References
Common violations. ParityTrack. (n.d.). https://www.paritytrack.org/common-violations/#
Timothy’s law. EmblemHealth. (n.d.-a). https://www.emblemhealth.com/legal/timothys-law#:~:text=Timothy%27s%20Law%20is%20a%20New,minimum%20benefits%20for%20mental%20illness.
Wolf, C., Broutman, E., & Stern, D. (2022, January 12). An overview of timothy’s law: Past, present, and future. Behavioral Health News. https://behavioralhealthnews.org/an-overview-of-timothys-law-past-present-and-future/
Hill, M. (2003, June 22). Parents of suicide victim urge changes in insurance. Los Angeles Times. https://www.latimes.com/archives/la-xpm-2003-jun-22-adna-tim22-story.html
