Does My Health Insurance Cover Mental Health Treatment?
Each year, more than 5 million American adults experience a major depressive episode and do not seek treatment, according to a recent NerdWallet study. For some, the stigma associated with mental illness keeps them from seeking help, but others may be avoiding treatment simply because they are unsure of whether they can afford it or whether their health insurance covers it. While insurance coverage for mental health treatment is more widely available and comprehensive thanks to recent changes, some say it still doesn’t go far enough.
If you purchased your health insurance through state exchanges set up by the Affordable Care Act, mental health care is covered. It is one of the 10 benefits that must be covered on all plans under the law. If you have insurance through your employer, there’s a pretty good chance you’re covered, too. A Society for Human Resource Management survey of 2014 employee benefits found that 87% of employer health plans cover mental health treatment. But exactly what mental health services are covered under these plans varies and depends on what medical services are covered.
Mental health parity law
Historically, mental health coverage had been treated as a less important health concern than medical coverage by the insurance industry. That has changed over the years, culminating with the passage of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act in 2008. Also referred to as the mental health parity law, the act essentially mandates mental health and substance abuse coverage to be comparable to physical health coverage.
“New efforts are underway to expand coverage to the millions of Americans who have lacked access to affordable treatment for mental and substance use disorders,” said Labor Secretary Thomas Perez, upon passage of the final parity rules. “These rules will increase access to mental health and substance abuse treatment, prohibit discriminatory practices and increase health plan transparency. Ultimately, they’ll provide greater opportunities for affordable, accessible, effective treatment to Americans who need it.”
The parity law says that insurance policies covering mental health care must treat that care as they do other medical coverage. If you generally pay a $40 copay for doctor’s appointments and treatments, for instance, an appointment with your psychologist can’t carry a higher price tag.
Before the final rules of the parity law took effect, patients in need of mental health treatment would often have to seek pre-approval for coverage, and even then, they would be limited to a certain number of visits per year. That is no longer the case. Though health insurance companies can always review whether covered treatments are necessary, they can no longer put arbitrary caps on mental health visits that they wouldn’t put on medical appointments.
Depending on the specifics of your policy, and whether similar medical treatments are covered, your mental health coverage can include: emergency room visits, hospital stays, individual and group therapy appointments, psychiatrist visits and coverage for mental health prescriptions.
Plans still not required to have mental health coverage
“The parity law, on paper, certainly appears to be an improvement in health care policies”, says Lisa Blackstock, a patient advocate from Soul Sherpa. “The key is whether or not your policy covers [mental] health care.”
The law does increase the quality of care for those who have mental health coverage, but it does not mandate mental health coverage on all policies. Instead it requires health insurance plans that do cover mental health treatment to cover it on par with medical treatment. The American Psychological Association points out there are some programs exempt from the parity law. Some state government employee plans can opt out of parity requirements. Likewise, Medicare is not subject to the law.
Even if mental health coverage is available, some providers may not accept your insurance. Blackstock told NerdWallet that mental health providers are often reluctant to accept these policies because reimbursement rates are so low.
If you are unclear about your coverage, consult your description of plan benefits or contact your insurance carrier directly.
Deductibles, copays still apply
The parity law, along with requirements under the ACA, may mean mental health care is more accessible than ever. But that doesn’t mean there aren’t costs. Just like your medical care, mental health care is subject to copays, coinsurance, deductibles and other out-of-pocket costs. It is likewise still subject to coverage denials from insurance companies.
You can prepare for these costs by becoming familiar with your plan’s coverage specifics before you seek mental health treatment. If you receive an unexpected denial or higher-than-anticipated bills after treatment, you may find help through a medical bill advocate.
Blackstock says patients with mental health questions shouldn’t be afraid to get help.
“My advice to all persons regarding emotional well-being and mental health is to maintain a strong support group, be open when stress gets to be too much, and don’t be hesitant to appoint an agent for you in your advance health care directive who you can trust to help navigate your care when the going gets tough,” Blackstock says. “If you incur a big bill for mental health treatment that isn’t covered by insurance, find a patient advocate with a proven track record in bill negotiation … Someone needs to pick it apart and aggressively advocate on your behalf, not unlike an attorney or Realtor doing their job in their respective fields.”
Therapy photo via Shutterstock.