Insurance Denial of Mental Health Claims: Understanding Your Rights Under the ACA

Health insurance costs can be a significant financial burden for many Americans. That’s why it’s important to understand your rights under the Affordable Care Act (ACA) to ensure you have access to affordable and comprehensive healthcare coverage.

What the ACA Says About Mental Health Coverage

One of the key provisions of the ACA is that all health insurance plans must cover essential health benefits, including mental health and substance abuse treatment. This means that insurers cannot deny coverage for mental health services simply because they are mental health services.

Exceptions to the Rule

There are a few exceptions to this rule. Grandfathered plans, which are plans that were in effect before March 23, 2010, are not required to cover mental health benefits. However, if a grandfathered plan does offer mental health coverage, it must do so at the same level as physical health coverage.

What You Can Do If Your Claim Is Denied

If your insurer denies your claim for mental health services, you have the right to appeal the decision. You should follow the appeals process outlined by your insurer. If you are unable to resolve the issue through the appeals process, you can file a complaint with the state insurance department or the federal government.

How to Get Help

If you need help finding affordable health insurance coverage, you can visit or contact a licensed insurance agent. If you have been denied coverage for mental health services, you can contact a mental health advocate or attorney for assistance.


The ACA has made it illegal for most health insurance plans to deny coverage for mental health services. If you have been denied coverage, you have the right to appeal the decision. With the right help, you can get the mental health coverage you need.

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