Claiming insurance for your mental health care is often more difficult than it should be, especially because your condition may affect your stress level and ability to deal with policy details.
Knowing as much as possible about your health insurance policy will help you understand what you can claim and how to get the best mental care available.
Some insurance companies may have different rules regarding mental health care than those for physical health care. While there are efforts being made to prevent this, understanding key terms relating to your treatment and your policy can help you stay in control of both. It is important to know your rights, as well as areas where you may experience difficulties, in order to plan your treatment in advance. This way, you will not need to waste time and energy during the course of your treatment and can instead focus on improving your mental health.
Mental health care is one of the ten types of care that must be covered by health insurance. The exact treatments covered by your insurance plan will vary, but there should be some type of coverage. Marketplace health insurance plans cannot put dollar limits on your mental health coverage or deny you coverage because of a pre-existing mental health condition.
Many health insurance plans should also provide “parity” between mental health care coverage and other health care, according to the Mental Health Parity and Addiction Equity Act (MPHAEA). This means the company may not demand a higher copay or deductible for your mental health care treatments. They also may not put stricter limits on the days allowed for treatment or the rules regarding your case management.
Every health insurance policy will vary, particularly when it comes to mental health care coverage. Because of this, it is vital to check your policy thoroughly before seeking treatment. Below are some points to look at on your policy:
When planning your treatment, you need to understand what types of treatment your policy will cover and to what extent. This will enable you to work together with your mental health provider to come up with an affordable plan. Your insurance might cover the following mental health treatment types:
If you are enrolled in Medicaid, you will be covered for at least some types of mental health treatments. The specific treatments available to you will vary by state. The treatment available to children enrolled in the Children’s Health Insurance Program (CHIP) should provide any essential mental health benefits. This includes substance use disorder benefits.
Medicare covers several types of mental health treatments within its various categories. For example, Medicare Part A covers hospital visits, so it also covers hospitalization for a mental illness. Part B, medical care, covers outpatient mental health treatments, and Part D covers medications. The exact treatments available, however, will vary depending on your plan.
If you have been denied mental health coverage for any reason or if your policy is difficult to understand, it is important to seek help. If you have workplace health insurance, ask to speak to your Human Resources department. Otherwise, seek help from your doctor’s office or from a friend or family member.
If you suspect your insurance policy is not in compliance with Parity Law, you should request a summary of your benefits and coverage. You may also contact the U.S. Department of Labor’s Employee Benefits Security Administration for further assistance. For issues with private insurance, contact your state Insurance Commissioner’s office or state Insurance Department.
Some mental health providers will not accept insurance, as the rate of reimbursement can be very low. Because of this, it is important to check whether your insurance will be accepted before starting any kind of treatment. If you have workplace health insurance, you should mention any refusals to your Human Resources department, as they may need to change their rates of reimbursement.