TRICARE Denied Your Mental Health Treatment?
TRICARE (Military Health System) denies 12% of claims on average. But 55% of appeals succeed when patients fight back. Your mental health treatment denial may have grounds for a successful appeal.
Why TRICARE Denies Mental Health Treatment
Session limits or visit caps
Not medically necessary per reviewer assessment
Provider not in-network
Diagnosis not covered under plan
TRICARE's Common Denial Tactics
Denying non-network care when network providers unavailable
Prior authorization requirements for specialty referrals
Classifying care as not medically necessary per DoD criteria
How to Win Your Mental Health Treatment Appeal
Cite MHPAEA — mental health must be covered at parity with medical/surgical
Document treatment necessity from psychiatrist or psychologist
Show that denial applies stricter criteria than comparable medical treatment
File with DOL if ERISA plan violates parity requirements
Laws That Protect You
Mental Health Parity and Addiction Equity Act (MHPAEA)
ACA Essential Health Benefits — Mental health is required
State mental health parity laws
Tips for Appealing to TRICARE
TRICARE appeals go through the Defense Health Agency, not state regulators
Cite DoD medical necessity criteria specifically
Request a formal reconsideration before escalating to the DHA
Ready to Fight Your Mental Health Treatment Denial?
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This information is for educational and informational purposes only. It does not constitute legal or medical advice. Statistics cited are from publicly available sources including KFF, HHS OIG, and state insurance department data. Individual results may vary. Consult a qualified professional before taking action on your specific situation.