In terms of well-being, mental health is just as important as physical health. However, it has not always seemed that way in the eyes of the insurance companies. Previously, little emphasis was placed on the importance of mental health as a component of overall well-being. And a lot of insurance plans simply did not provide care for those with mental health issues.
Now, with the Affordable Care Act (ACA), mental health benefits have become more widely available to those in need. When the ACA was signed in to law in 2010 there were strict guidelines as to what each plan must cover. All plans were to include benefits such as maternity care, preventative services, and mental health care.
In terms of mental health benefits, all plans must cover three things: behavioral health treatment, such as psychotherapy and counseling, mental and behavioral health inpatient services, and abuse treatment. Also, you will not be penalized for a preexisting condition, such as depression. And thanks to the ACA, a majority of plans cover preventative mental health services, such as behavioral assessments and depression screenings.
This is all great news, but some people do not even know that their health insurance plans provide mental health care. Therefore, I have put together a list of things you should know about your coverage.
First, mental health issues must be covered equal than or greater than the coverage provided for medical or surgical treatments. This means that all copays must be equal across the board. Your charge for a visit with your psychiatrist is the same as an appointment with your orthopedic surgeon.
Also, there is no annual maximum in terms of treatment visits. Insurance companies are prohibited from putting a financial cap on treatments. However, they can limit the number of visits based off of medical necessity. Once you see a psychiatrist they set up a treatment plan, at the end of that treatment plan there is a reevaluation. If they feel your care still is medically necessary, your insurance is required to continue to pay for your treatment.
Second, all mental health diagnoses are covered under the federal parity law, whether it is a disease, such as schizophrenia, or a substance abuse problem. However, specific health plans are allowed to exclude certain diagnoses in any area of mental or physical health.
Third, it is important to remember that not all doctors take your insurance, even if you have mental health coverage. A lot of mental health providers are “not in network” with many insurance companies because their reimbursement rates are so low. Therefore, it is important to check if a provider is within your network before scheduling your first appointment
It is extremely important to know and to understand what your insurance company covers. Also, before you schedule your appointment you should call and find out what your deductible is, what your copay is and any other pertinent information. This will help you to save money and to save time.