Mental Health Therapy and Insurance Coverage

0
16
Mental Health Therapy
Mental Health Therapy

Mental health therapy is expensive, no doubt about it, you can dial any mental health therapy institution and just ask for the price for a single session, you won’t be surprised, it is going to be expensive. The price goes up with the severity of the problem you are encountering, and not just because of the number of the sessions needed, but also because of the degree of expertise the therapist has to have to treat you, and because of the price of the medications you will be prescribed. Good thing is that mental health therapy is becoming more affordable just like life insurance, health insurance, car insurance, and can be covered by your health insurance – check here!

In 2008 the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act law has passed (more commonly known as the Mental Health Parity law or Federal Parity Law). What does this mean? The law requires coverage of services for mental health, behavioral health, and substance-use disorders to be comparable to physical health coverage, meaning you are now eligible for mental health therapy covered by your health insurance! This act requires that all companies that offer health insurance will treat mental health disorders and substance use disorders just as any medical or surgical coverage. It means that they won’t be able to charge more copay than they charge for most medical or surgical office visits, nor will they be able to limit the number of mental health visits, as they did in the past.

The federal parity law is specific and applies to certain types of health insurance:

– Employer-sponsored health coverage – for companies with 50 or more employees.

– Coverage purchased through health insurance exchanges.

– Children’s Health Insurance Program.

– Most Medicaid programs (can vary from program to program; contact your state Medicaid director for more info). Don’t confuse it with Medicare, because it is not subject to the federal parity law!).

By now you are surely interested if your health insurance plan is covering mental health or substance use disorder services in parity with medical or surgical benefits? If you are a part of a large employer plan, you are probably subject to the parity protections required under Mental Health Parity law. However, for any further questions, you should take a look at your plan’s enrolment material to check your coverage level for any benefits. Contact your medical insurance agent, by the same act they are obliged to provide you with an easy to understand summary about your benefits regarding your mental health coverage, as well as your medical or surgical coverage. Or if you are a part of a large company insurance plan, check with your human resources department, they will help you with any question you have in detail!

This, however, does not mean that the parity law states that you have to have mental health benefits, it just clearly states that the mental health benefits offered cannot have more restrictive requirements than those applied to physical health benefits, meaning you won’t pay more for mental health benefits than you pay for physical health benefits. This also applies to copay, meaning you won’t pay more copay than for any medical or surgical service offered!

Even if you already have mental health coverage, your mental health provider can still refuse to accept your insurance, so don’t be surprised if this happens. This is because many insurance companies have not increased the reimbursement rate for the last 10 or 20 years, and because of the high administrative costs for running a practice, a lot of mental health professionals have chosen not to participate in the network. If this is your case, and your insurance is provided through your employee, try talking to human resources, they might take you in consideration when planning your insurance in the future negotiations with the insurance companies.

In case none of the above applies as a solution to your problem, try considering other option, because there are other options, and they can just be the solution you are looking for:

  1. Talk to your insurance agent – there are insurance plans that can offer you a list of professionals that specialize in the issue you are looking for help for, and you might only have to pay a small portion for the service. You should also check of your coverage doesn’t cover therapy; it just might cover social worker or psychologist assistance.
  2. Community mental health center – it can either free or low costs and are covered by Medicaid insurance.
  3. Support groups – most of these groups are free and are led by professional volunteers.
  4. Training clinic – typically located on universities, these clinics are run by students as part of their training program and are always supervised by professional psychologists and mental health therapists with highest profiles.
  5. Books, podcasts, and videos – written and made by mental health professionals, these materials have been shown as a great way to help yourself.
  6. Online therapy – this method of therapy is a lot more affordable than conventional therapy and can costs 4-5 times less, and you can expect the same results. It is usually applied for less severe mental health problems, such as anxiety, mild depression, work-related mental issues, substance abuse disorder, or relationship/marriage problems. The options using this method are countless, from group therapy to telephone therapy, to e-mail therapy!

If you are struggling with a chronic, severe mental illness that incapacitates you from doing your job, you are probably eligible for disability benefits. This option should be your last refuge because not only the process for applying is long and complicated, but it does not necessarily mean you will get health insurance. It means that after receiving disability benefits you will become eligible for Medicare, and if disabled, you are also eligible for Medicaid, together with the mental health benefits provided by both.

Whatever you are struggling with, ask for help, either from your insurance agent, or look for advice from some online clinic. The solution to your problem is out there somewhere, take time, and inform yourself, and you will find a solution.

References:

  1. https://www.betterhelp.com/advice/therapy/does-health-insurance-cover-therapy-for-mental-health-or-do-i-have-to-pay/
  2. https://www.apa.org/helpcenter/parity-guide
  3. https://www.mentalhealth.gov/get-help/health-insurance
  4. https://psychcentral.com/blog/what-to-do-when-you-cant-afford-therapy/
  5. https://www.verywellmind.com/how-to-get-mental-health-insurance-using-it-wisely-1738985
SHARE
I'm NOT a doctor! I'm just passionate about health and healthy leaving. The information on this website, such as graphics, images, text and all other materials, is provided for reference and educational purposes only and is not meant to substitute for the advice provided by your own physician or other medical professional. The content is not intended to be complete or exhaustive or to apply to any specific individual's medical condition.

LEAVE A REPLY

Please enter your comment!
Please enter your name here