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New Guidance on the Mental Health Parity and Addiction Equity Act
Segal ConsultingLink to more items from this source
[Guidance Overview]
Dec. 17, 2015

"A plan administrator or health insurer cannot refuse to provide the plan's medical necessity criteria on the basis that the information is proprietary or has commercial value. A plan administrator or health insurer may provide an understandable summary of the plan's medical necessity criteria, but this not a substitute for providing the actual criteria when requested. Some determinations made by non-grandfathered plans are subject to external review."

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