Here are some links and resources for you to pass on regarding the importance of single case agreements between a patient and their insurance or a network deficiency exemption.

With a diagnosis of OCD, people are legally entitled to the in-network rate coverage from their insurance for a specialist in OCD. An insurance company is obligated to cover an out-of-network provider who is able to provide the necessary care. The same is true for OCD."

This website has an excellent write-up on how to go about this process:

https://soartogether.net/2021/03/22/insurance-ocd/

Here is some information about SB855 which is specific to California and went into effect on January 1st, 2022.

https://www.calbhbc.org/uploads/5/8/5/3/58536227/sb_855_-_fact_sheet_and_background_info.pdf

Here is some information about network gap exemptions:

https://help.niermanpm.com/knowledge/what-is-a-gap-exception-and-how-to-get-one

https://www.verywellhealth.com/network-gap-exception-what-it-is-how-it-works-1738418

https://content.naic.org/cipr-topics/network-adequacy

The important piece on this website regarding federal law HR 133 is this:

Starting January 1, 2022, both providers and health plans must treat out-of-network services as if they were in-network when calculating patient cost-sharing, with the notable exception of ground ambulance transport. The NAIC’s Health Insurance and Managed Care (B) Committee is working closely with the federal government and other stakeholders to implement the No Surprises Act.

Here is information about how laws are strengthened in 2023. https://www.healthaffairs.org/do/10.1377/forefront.20220430.953129/

Here's another handy website:

https://themighty.com/wp-content/uploads/2020/10/Guide-to-Using-Health-Insurance-to-Get-Mental-Health-Care.pdf

For additional assistance working with your insurance company to resolve coverage issues, the Health Consumer Alliance (HCA) may be able to help.

HealthConsumer.org 888‐804‐3536

Complain to California Dept of Managed Health Care

https://www.dmhc.ca.gov/FileaComplaint.aspx#.WOfOl_nytlY

California Department of Insurance

The California Department of Insurance (CDI) is responsible for regulating health insurance plans sold through the Blue Shield of California Life & Health Insurance Company (Blue Shield Life). If you have a grievance against your Blue Shield Life plan, you should first file using Blue Shield’s grievance process.

If you’re not satisfied with how the grievance is resolved, you or your provider may ask for a review through the CDI Health Claims Bureau:

By phone:

(800) 927-HELP (4357) TTY: (800) 482-4833) 8 a.m. to 5 p.m., Monday through Friday (excluding holidays)

By writing to:

California Department of Insurance, Health Claims Bureau

300 S. Spring St., South Tower

Los Angeles, CA 90013

This law firm has some really great info:

https://scottglovsky.com/insurance-bad-faith/health-claim-denial/mental-health/substance-abuse-insurance-denial/