With the passage of the Affordable Care Act, several steps have been taken to ensure better coverage for Americans with mental health conditions and addiction, including changes that require insurance companies to cover mental health services at the same level as other medical services.
But what this means in practice varies from state to state (and plan to plan), sometimes to a significant degree. If you or a loved one is experiencing mental health issues, here are some ways to ensure that you are getting the best level of care:
Contact Mental Health Facility
No provider can guarantee your insurance will cover their services, but chances are that the mental health professionals and their administrative staff are much more experienced than you are at asking the right questions. In fact, many inpatient treatment programs have representatives who are there specifically to help prospective clients navigate insurance and coverage issues. If you are considering inpatient treatment, contact the treatment center directly and ask to speak to a financial specialist. They will help you understand the right questions to ask, and may even contact your insurance company on your behalf. Similarly, outpatient mental health providers often employ client advocates or, at the very least, have someone who can answer basic questions about coverage and care.
Use Preferred Providers
As with other medical services, some insurance companies offer better coverage if you use a preferred provider. Others want to know that you are seeing a licensed practitioner. Before seeing a therapist or mental health provider, find out whether they meet your insurance company's licensure requirements, otherwise your services may not be covered.
Check Visit Restrictions
Some insurance policies limit the number of therapy visits consumers can have within a certain time period. See if your insurance policy has any such restrictions before agreeing to weekly therapy. Sometimes a mental health provider will be able to petition for additional visits on your behalf. In some cases, this type of restriction may violate new mental health parity requirements.
If your health insurance won't cover the level of services you need, there are ways to get supplement services at little to no cost. If your insurance limits the number of therapy visits per year, check into group therapy services, which are sometimes less expensive or not as restricted. Many peer-support groups are free, and are a great way to supplement professional services. Finally, community mental health centers sometimes offer sliding-fee services or reduced rates to those who qualify to see a practitioner-in-training.
The Bottom Line
The expansion of mental health coverage is a step in the right direction for equal coverage, but disparities still remain. As with other types of coverage, it's always best to contact your insurance company directly in order to understand what is and isn't covered. For more information, go to www.mentalhealth.gov.
For health insurance questions, call or contact Executive Insurance & Financial Services today.