Check SCREEN READER MODE to make this survey compatible with screen readers.
Arizona Coalition for Insurance Parity
Mental Health Parity Story Collection Form
Have you or someone you know been denied coverage for mental health or substance use disorder treatment in the state of Arizona? If so, the Arizona Coalition for Insurance Parity wants to hear from you.
The Arizona Coalition for Insurance Parity is collaboration between the Arizona Council of Human Service Providers, JEM Foundation, Mental Health America of Arizona, and the Neighbors Council. We are working to ensure that Arizonans are able to easily access appropriate and timely mental health and substance use disorder treatment through their medical insurance.
Please fill out this survey if you, or someone you know, has been unable to access needed behavioral health services or had a claim denied for mental health and/or substance use disorder treatment. The information you provide will help us to shape public policy and influence legislation in order to move us towards full parity implementation and mental health equity.
By completing this survey you are acknowledging that your information is being collected to help understand the current trends and circumstances surrounding mental health and substance use disorder treatment claim denials in Arizona. All information you provide will be kept confidential, and any identifiable information you choose to provide will not be shared without your permission.