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
      • Partial Hospitalization (PHP)
      • Intensive Outpatient (IOP)
      • Outpatient
      • Cost of Treatment
  • Eating Disorder Resources
    • For Referring Providers
      • Hospitalization Criteria
      • Direct Referrals
    • For Parents & 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
    • 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
      • Alex Garcia MA
      • Lisa Peacock LMFT
    • Contact Us
    • Careers at Kartini
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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

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

Online Reviews

September 23, 2021 By Morgan O'Toole-Smith

Tips for Motivating Kids in School

January 19, 2021 By Morgan O'Toole-Smith

Dr. O’Toole to retire at the end of 2020.

December 16, 2020 By Morgan O'Toole-Smith

Breaking Science News: The Latest Genetic Study of Anorexia Nervosa

July 18, 2019 By Julie O'Toole

  • 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
      • Partial Hospitalization (PHP)
      • Intensive Outpatient (IOP)
      • Outpatient
      • Cost of Treatment
  • Eating Disorder Resources
    • For Referring Providers
      • Hospitalization Criteria
      • Direct Referrals
    • For Parents & 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

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From Our Blog

New to Treatment? Don’t Panic!

February 10, 2022

Your child has been diagnosed with an eating disorder by one of the doctors at Kartini Clinic. Whether this is a restricting disorder with fear of fat, a bingeing and purging disorder or what we call ARFID (avoidant restrictive food intake disorder), it matters little.  What matters is that the … Read Post...

Kartini School: A Success Story

February 9, 2022

[Ed. note: This is one in a series of guest blogs by our Kartini School administrator, Mary Gunesch. With schools returning to at least partial in-person instruction we thought it a good time to focus on this subject.]  When a student begins treatment at Kartini Clinic, we reach out to their … Read Post...

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...

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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