Share Your Insurance Story

Please complete the questions below to share your story.

  1. Do you or a family member have employer-provided group health insurance AND have been denied mental health benefits (either treatment was denied OR treatment was cut short because of insurance limits)?
    YES     NO

  2. Do you or a family member have employer-provided group health insurance AND either did not get mental health treatment due to high cost-sharing requirements, such as co-payments, or endured a financial hardship as a result of seeking treatment?
    YES     NO

  3. (a) Please provide a detailed account of your or your family member’s experience with treatment limitations and/or financial requirements on mental health benefits under your group health insurance plan.


    (b) Please explain how these insurance problems affected your or your family member’s health, well-being, employment, school performance or other aspect of life.

    (c ) How might your experience or the experience of your family member have been different if your insurance plan’s mental health benefits were comparable to medical and surgical benefits?
  4. Please provide the following optional information. Be sure to indicate which items you wish to remain confidential.
    (a) I am a resident of (locality and state)


    (b) My name is (If you do not want us to use your full name, may we use your first name?)

    (b1) Your email address

    (c) Mental health history.

    (d) School and employment history.
    (e) Check the appropriate line(s) that best described you or your family member:
    adult
    senior citizen
    child
    adolescent

spacer


Contact us for more information:

Telephone: 800-969-NMHA (6642)
Mail: NMHA, 2000 N. Beauregard Street,6th floor, Alexandria, VA 22311
TTY: 800-433-5959
E-mail: infoctr@nmha.org