Kartini Clinic for Children and Families

Pediatric Eating Disorder Treatment Program

Get Help Now:
971-319-6800
  • Eating Disorder Treatment
    • Anorexia Nervosa
      • Signs & Symptoms: Anorexia
      • Causes and Triggers: Anorexia
      • Treatment: Anorexia
    • Bulimia Nervosa
      • Signs & Symptoms: Bulimia
      • Causes and Triggers: Bulimia
      • Treatment: Bulimia
    • Food Phobia
      • Signs & Symptoms: Food Phobia
      • Causes and Triggers: Food Phobia
      • Treatment: Food Phobia
    • ARFID
    • Treatment Overview
      • Inpatient
      • Kartini Clinic Partial Hospitalization Program
      • Intensive Outpatient (IOP)
      • Virtual Intensive Outpatient (VIOP)
      • Outpatient
      • Cost of Treatment
  • Eating Disorder Resources
    • For Referring Providers
      • 8 Important Hospitalization Criteria
      • Provider Referrals to Kartini Clinic
    • Kartini School
    • For Parents and Guardians
      • Top Tips for Parents
      • Understanding Your Insurance
      • Talking to Your Employer
      • Insurance FAQ
      • Mental Health Parity Law
      • Family Housing Information
      • School During Treatment
      • Give Food a Chance
    • Research & Resources
    • Eating Disorder Treatment Videos
    • Glossary of Eating Disorder Terms
  • About Kartini Clinic
    • Why Kartini is Different
    • Will Treatment Work?
    • Our Staff
      • Julie O’Toole MD MPH
      • Naghmeh Moshtael MD
      • Shanna Greene
      • Morgan O’Toole
      • Megan Maples
      • Sherrill Gandsey RN
      • Leslie Weisner LMFT
      • Steve Nemirow
      • Amy Stauffer
    • Contact Us
    • Careers at Kartini
  • Blog
    • Facebook
    • LinkedIn
    • YouTube

Mental Health Parity Law

Q: What is Oregon’s mental health parity law?
A: The mental health parity law (Senate Bill 1) was passed by the 2005 Oregon Legislature. It requires group health insurance policies to cover treatment of chemical dependency and mental or nervous conditions at the same level and with no more restrictions than those imposed for other medical conditions. Updates to the law’s regulations can be found here.

Q: When did the Oregon mental health parity law take effect?
A: The law was effective January 1, 2007, for new group health insurance policies and, for renewal policies, the first renewal date after January 1, 2007. Please contact your insurance company representative to confirm the effective date of parity for your plan.

Q: Does mental health parity apply to all types of health insurance?
A: No. The law doesn’t apply to the following types of insurance:
• Individual health insurance plans
• Self-insured employer group health plans
• Medicare
• Medicaid

Q: What is a “mental or nervous condition”?
A: A mental or nervous condition is defined as any disorder listed in the “Diagnostic and Statistical Manual of Mental Disorders,” published by the American Psychiatric Association.

Q: Can my insurance company require me to pay more for mental health prescription drugs than for drugs for physical health conditions?
A: Insurers must use the same classification of prescription drugs, such as open, closed or tiered drug benefit formularies, for both mental and physical conditions. You may be charged more if your mental health provider prescribes a preferred brand drug instead of a generic brand.

Q: Are treatment plan review procedures the same whether a provider is participating, preferred, or non-participating?
A: Yes, the treatment plan review procedures are the same for all professionals.

Q: How is “medical necessity” defined?
A: The law does not define medical necessity, but it does require insurance policies to contain a single definition of medical necessity that applies uniformly to all medical, mental or nervous conditions, and chemical dependency, including alcoholism. Contact your insurance company directly to get the policy definition.

Q: My patient’s insurance company is now requiring preauthorization and treatment
plans. They have never required these before. Can the insurance company require all mental health treatment to be preauthorized?
A: Coverage for expenses for treatment of mental or nervous conditions and chemical dependency, including alcoholism, may be managed through common methods that include selectively contracted panels, health policy benefit differential designs, preadmission screening, prior authorization, case management, utilization review, or other mechanisms designed to limit eligible expenses to treatment that is medically necessary in the same manner that such methods are used for other medical conditions.

Q: What if an insurer denies coverage for mental health or substance abuse services that I believe are medically necessary, or the insurer says the treatment is experimental or investigational?
A: Consumers may appeal such denials both internally or externally through an independent external review organization.

Q: Who should consumers contact if they have questions about the Oregon parity law or other insurance questions?
A: Free help is available from the Consumer Advocacy Unit of the Oregon Insurance Division for consumers with insurance questions and complaints.

Consumer Advocacy Unit
Oregon Insurance Division
PO Box 14480
Salem, Oregon 97309-0405
(888) 877-4894 (toll-free)
(503) 947-7984 (Salem area)
www.insurance.oregon.gov

Recent Blog Posts

Are social media platforms making eating disorders in children worse?

January 10, 2023 By Morgan O'Toole-Smith

School During Eating Disorder Treatment? Not To Worry

October 13, 2022 By Morgan O'Toole-Smith

Online Reviews

September 23, 2021 By Morgan O'Toole-Smith

Spotting the Tiger: Identifying Early Symptoms of Eating Disorders in Children for Timely Intervention

May 8, 2023 By Morgan O'Toole-Smith

New to Treatment? Don’t Panic!

February 10, 2022 By Julie O'Toole

Kartini School: A Success Story

February 9, 2022 By Morgan O'Toole-Smith

  • Eating Disorder Treatment
    • Anorexia Nervosa
      • Signs & Symptoms: Anorexia
      • Causes and Triggers: Anorexia
      • Treatment: Anorexia
    • Bulimia Nervosa
      • Signs & Symptoms: Bulimia
      • Causes and Triggers: Bulimia
      • Treatment: Bulimia
    • Food Phobia
      • Signs & Symptoms: Food Phobia
      • Causes and Triggers: Food Phobia
      • Treatment: Food Phobia
    • ARFID
    • Treatment Overview
      • Inpatient
      • Kartini Clinic Partial Hospitalization Program
      • Virtual Intensive Outpatient (VIOP)
      • Intensive Outpatient (IOP)
      • Outpatient
      • Cost of Treatment
  • Eating Disorder Resources
    • For Referring Providers
      • 8 Important Hospitalization Criteria
      • Provider Referrals to Kartini Clinic
    • For Parents and Guardians
      • Top Tips for Parents
      • Understanding Your Insurance
      • Talking to Your Employer
      • Insurance FAQ
      • Mental Health Parity Law
      • Family Housing Information
      • School During Treatment
      • Give Food a Chance
    • Kartini School
    • Research & Resources
    • Treatment Videos
    • Glossary of Eating Disorder Terms
  • About Kartini Clinic
    • Why Kartini is Different
    • Will Treatment Work?
    • Our Staff
    • Contact Us
    • Careers at Kartini

TEST SEARCH

How to Recognize Eating Disorders in Boys

https://www.youtube.com/watch?v=PVgVmDIXqHc

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From Our Blog

Online Reviews

Are social media platforms making eating disorders in children worse?

January 10, 2023

At least one school district in Seattle thinks so. Seattle Public Schools (SPS) has filed a suit in US DIstrict Court alleging that “defendants [social media platforms such as Facebook, TikTok, Instagram, YouTube, and Snapchat] affirmatively recommend and promote harmful content to youth, such as … Read Post...

School During Eating Disorder Treatment? Not To Worry

October 13, 2022

During the school year, families are sometimes hesitant to have their child enter treatment in the Partial Hospitalization Program (PHP) because they are worried about time away from school. The teachers at Kartini School understand your concern.  Often, our patients are super-conscientious … Read Post...

Provider Referrals Kartini Clinic

Online Reviews

September 23, 2021

This post is from Kartini Clinic CEO Morgan O'Toole.  Online reviews have become part of our everyday lives. Who hasn’t glanced at the star ratings when Googling a new hair salon or looking for a restaurant to try out? Most of the time, online reviews are just another useful data point when … Read Post...

For Referring Providers Kartini Clinic

Spotting the Tiger: Identifying Early Symptoms of Eating Disorders in Children for Timely Intervention

May 8, 2023

In the powerful documentary, "Spotting the Tiger," narrated by Oscar Award Winner Jamie Lee Curtis, the film emphasizes the importance of recognizing early warning signs of eating disorders in children. As we commemorate its 15th anniversary, the core message of this film remains just as relevant … Read Post...

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The Kartini Clinic Difference

At Kartini Clinic we practice only evidence-based, family-centered eating disorder treatment. Our program is a multi-disciplinary medical and psychiatric treatment model rather than an exclusively psychiatric approach to eating disorder treatment.  read more »

Eating Disorder Quick Links

Anorexia Nervosa
Bulimia Nervosa
Eating Disorder Treatment

Resource Quick Links

Referring Providers
Parent Resources
Understanding Insurance

Contact Us

Tel: (971) 319-6800
Fax: (503) 282-3409

help@kartiniclinic.com

3530 N Vancouver, Suite 400
Portland, OR 97227

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Mon – Fri 9:00am – 5:00pm

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