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Fall 2022  Volume 15, Number 3        

mental health

What You Need to Know About Mental Health Care Insurance

Treatment for mental illness, which affects millions of Americans every year, can be costly, but many people don’t realize they qualify for mental health care insurance.

Does Your Insurance Cover Mental Health Treatments?

Many people pay for therapy out of pocket to avoid the hassle or potential embarrassment of using their insurance. However, most insurance plans now cover mental health care. You may have to pay a higher deductible or copay, but your treatments will be covered. How do you know if you have coverage? First, if you’re employed, check with your employer. Companies with more than 50 employees are legally required to offer mental health benefits. Smaller companies with fewer than 50 employees don’t have the same legal requirement but might still provide mental health benefits.

If you’re not sure whether your company offers mental health benefits, you can also check with your insurance carrier directly. They can tell you what benefits are available under your plan.

Note that any plan purchased through the Health Insurance Marketplace must offer ten critical health benefits, including services for mental health and substance use disorders. If you’re on a Medicaid plan, you’re also likely to have coverage for mental health and substance use disorder services.

With Medicare, you’re generally covered for outpatient mental health services, including individual and group therapy. You might also have inpatient mental health care coverage if it’s considered medically necessary.

What Types of Mental Health Services Are Covered?

The types of mental health services covered by insurance can vary depending on the insurer, the plan, and your location. Here are some examples of the types of treatment that might be covered:

  • Psychotherapy and counseling: can be used to treat various issues, including stress, grief, trauma, eating disorders, and substance use disorders.
  • Telemedicine and online therapies: allow patients to receive psychiatric care over the phone or online, rather than having to see a doctor face-to-face. Some telehealth options include video chats, telephone calls, text messaging, and email exchanges.
  • Emergency services: can be used in cases where someone is experiencing a mental health crisis or significant behavioral change and needs immediate care. This includes attempts at self-harm, substance abuse, suicidal thoughts and behaviors, psychosis, and violence.
  • Substance use disorder treatment: can help people struggling with alcohol or drug dependence. This might include detoxification, counseling, and medication-assisted treatment.
  • Co-occurring conditions: refers to people who have more than one mental health diagnosis, such as depression and anxiety.

What to Do If Your Insurer Won’t Pay

Insurance companies may deny a claim for mental health services for various reasons, including missing information, lack of coverage for that service, a billing mistake, or the service not being considered medically necessary. You have a few options if your insurance company denies a claim. First, contact your insurer to find out why the claim was rejected and see if there’s anything you can do to fix the problem.

You can also file an appeal with your insurance company or contact your state’s insurance department. Another option is to reach out to a mental health advocacy organization for help.

What If You Don’t Have Insurance?

You have several options if you don’t have insurance or if your insurance doesn’t cover mental health care.

You can contact your state’s mental health authority to find out about free or low-cost mental health services in your area. Also, look into free clinics and nonprofit options via the National Association of Free and Charitable Clinics.

Another option is to contact a university training program near you, as many offer low-cost mental health services provided by students who are supervised by licensed therapists. You can also look into online therapy, which is becoming increasingly popular. Many online therapy providers offer a free or low-cost trial period, so you can try out the service to see if it’s a good fit for you.

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In this issue:

This Just In...

Retirees Should Check Their Medicare Coverage Before Traveling

What You Need to Know About Mental Health Care Insurance

How to Save on Health Insurance

A Quick Look at Child-Only Health Insurance




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