Mental Health Coverage Kit: Find In-Network Care, Ghost Networks and Parity

You look up therapists in your plan's directory and start calling. Wrong numbers. Not taking new patients. Not in-network (participating) with your plan after all. In a 2023 U.S. Senate Finance Committee secret shopper test of 12 Medicare Advantage plans in six states, staff could get a mental health appointment only 18% of the time.

This kit helps you keep a record of every call, use the federal directory rules, and ask your plan for help in writing when no in-network provider can see you.

WHAT YOU GET

• Start here guide (PDF, 8 pages). How to check a directory listing and log your calls, the No Surprises Act directory rules for job-based and Marketplace plans, what to ask for when no in-network provider is available, out-of-network claims and superbills, parity basics and where the 2024 rule stands, a Medicare and Medicaid table, and crisis lines.
• Letters (Word, opens in Google Docs). A request for a network gap exception or single case agreement, a request for in-network cost sharing after a wrong directory listing, and a template note for a complaint to your state insurance department.
• Tracker (Excel, opens in Google Sheets). A directory call log with a summary tab that counts your results, an out-of-network claims and reimbursement log, and a plan contact log.

WHO IT IS FOR

Anyone trying to find in-network mental health or substance use disorder care, and the family members helping them. Written mainly for job-based and individual (including Marketplace) plans, with a page on how Medicare, Medicare Advantage, and Medicaid differ.

In crisis? Call or text 988, or call 911 if someone is in immediate danger.

SOURCES (checked November 2026)

42 U.S.C. 300gg-115 and CMS No Surprises Act pages, the Senate Finance Committee staff secret shopper report (May 3, 2023), eCFR (Medicare Advantage and Medicaid managed care access rules), CMS parity page, the May 15, 2025 Departments' statement, and Labor Department Field Assistance Bulletin 2026-03. Full list in the guide.

PLEASE NOTE

This is general educational information, not legal or medical advice. Plans and states have different rules. Always follow your own plan's notices. The Denial Desk is not affiliated with any health plan or government agency. For personal use only.

Your download link appears right after payment and is emailed to you.

• Free updates: when a rule or date changes, your download link gets the updated file.
• Can't pay right now? Email thedenialdesk@gmail.com with the subject "Free kit" and the name of the kit you need. No reason needed. Please don't include medical details, bills or insurance numbers. Limit one free code per email address, good for one kit.
• Questions or a problem with a file? Email thedenialdesk@gmail.com.
• AI disclosure: This kit was drafted with help from AI tools, then reviewed and fact-checked by our founder, a certified medical coding professional.