Mental health parity violations let insurers impose hidden visit caps on therapy

Despite the Mental Health Parity and Addiction Equity Act requiring equal coverage for mental and physical health, insurers routinely impose stricter utilization review on therapy visits than on comparable medical visits, effectively capping therapy at 20-30 sessions per year by requiring re-authorization every 6-8 visits with increasingly burdensome clinical documentation. A patient in treatment for PTSD finds their therapist spending 45 minutes per session on paperwork justifying continued treatment, time that could be spent on actual therapy. The DOL found parity violations in 73% of audited plans, yet enforcement actions are rare. This persists because the law requires "comparable" management of mental and medical benefits but does not define quantitative thresholds, giving insurers room to argue their review processes are technically equivalent while in practice being far more restrictive for behavioral health.