Therapy has always been a complicated service when it comes to health insurance. Does your health insurance cover therapy? If so, what types of therapy and mental health assistance does it cover? Additionally, what are the legal requirements for therapy coverage under public and private healthcare programs?
Fortunately, most health insurance providers will cover some form of therapy or mental health services. However, not all providers cover the same types of services and some only cover part of your expenses. Let’s dive into the details of insured mental health services and discover how to get coverage.
Quick Overview of Healthcare Coverage and Therapy
Not all health care providers will provide comprehensive coverage for mental health services, but most provide some level of coverage. Health care companies have strict requirements for treatments they consider necessary and worth covering. This means you will probably have to consult with a mental health professional to see if you can get coverage.
In other words, you need to receive a diagnosis from a licensed healthcare professional before receiving coverage from your health insurance company. If someone is unwilling to undergo this process for personal reasons, it is possible to pay out-of-pocket without bringing a diagnosis to your healthcare provider.
In other forms of medical coverage, a healthcare provider needs an identifiable code number to look up the corresponding coverage policy for your illness. The same applies to mental health coverage, as your insurance claim needs a diagnosis code to assess the cost of your treatment within your policy.
Legal Requirements for Employer Health Insurance
Many companies are legally required to provide health insurance for full-time workers of a certain capacity. If your company has 50 or more full-time employees, all full-time employees must receive some form of corporate health insurance.
However, not all health care policies will cover therapy or other mental health services. Even if your company is required to provide health insurance, a diagnosis code and corresponding policy coverage are still required to reduce or eliminate therapy costs.
Legal Exceptions for Employer Health Insurance
Smaller companies do not have the same resources and liabilities as companies with 50 or more full-time employees. For this reason, companies with under 50 full-time employees are not mandated to provide health insurance to their workers.
If a company of this size does provide health insurance, it must include coverage for substance use disorders, regardless of how the company purchases employee coverage.
Accessing Health Insurance Marketplace through Affordable Care Act
The Affordable Care Act makes it possible for anyone to afford coverage for substance use disorder and other mental health services. This includes all plans provided through the public Health Insurance Marketplace.
In order to qualify for the Affordable Care Act and access plans in the Health Insurance Marketplace, you simply need a United States residence and citizenship. These policies are available to anyone not currently serving time in prison.
Medicaid is a state-run and federally-funded health insurance program for affordable healthcare. Medicaid plans are required to cover substance use disorder and other essential healthcare services, provided that patients can receive a diagnosis.
Medicare, similar to Medicaid, is a federal health insurance program for affordable healthcare. These policies split coverage into different plans labeled Part A, B, C, and D.
Part A is designed for general inpatient treatment. In other words, if you are hospitalized for mental health reasons, Medicare Part A will reduce or cover the cost of your hospitalization and treatment as an inpatient.
Part B is designed for doctor’s visits, along with the external testing and healthcare work required of preventative services. This part of Medicare will cover coinsurance, copays, deductibles, and other out-of-pocket expenses for therapy and similar services.
Part C, also known as Medicare Advantage, will cover more therapy and mental health services than Part A and B. If you require greater mental health services than covered in Part B, this policy is a good idea.
Finally, Medicare Part D will cover the cost of prescription drugs that are used in the process of mental health treatment. As many mental health treatment programs involve prescription drugs, all four policies will help reduce the cost of your treatment.
Children’s Health Insurance Program
According to household income, not all households are eligible for Medicaid. In this case, children who aren’t eligible for Medicaid can still receive coverage under the Children’s Health Insurance Program, or CHIP for short.
Coverage under CHIP includes substance use disorder treatment, social worker services, medication management, therapy, counseling, and peer support. Under this coverage, cost reduction for therapy services is on the same level as other medical expenses.
How Can I Find Out if My Health Insurance Covers Therapy?
Ask Your Therapist
If you already have a therapist or mental healthcare provider, you can call and ask them about coverage costs and insurance plans. Not all healthcare providers are in the same network of healthcare coverage, so this approach can clarify your options.
Healthcare providers can check with insurance providers to determine if your health insurance covers treatment. If the treatment is outside your network’s coverage, you can modify your existing plan or switch to a new provider.
Call Your Insurance Provider
If you have not yet consulted a mental healthcare professional, you can contact your insurance provider directly and find out which services would be covered. Additionally, you can find out more about other options and plans to purchase.
Check Your Online Insurance Account
The fastest and most convenient way to check for mental healthcare coverage is to log on to your insurance provider’s online portal and review your plan. These sites provide lists of healthcare providers in your network’s coverage.
Talk to Your Employer’s Human Resources Department
Suppose your health complications are impacting your work. In that case, you can always contact your company’s human resources department and review services and providers that are covered in your company’s healthcare policy.
This is only a good option if you are comfortable sharing medical information with human resources at your company. However, you do not need to contact human resources to find information on mental healthcare coverage.
Which Mental Health Services Are Covered by Insurance?
Services covered by insurance include inpatient services, outpatient services, preventive services, and prescription costs.
Inpatient services include treatment received in a hospital or rehabilitation center. According to your insurance coverage, this includes a certain number of days under hospitalization. In other cases, it may include a maximum dollar cost for services.
Outpatient services include visits to healthcare professionals such as psychologists, psychiatrists, and social workers. This extends to any outpatient services considered medically necessary for your treatment.
Preventative services such as the above outpatient services are covered, as well as any other therapy treatment within your network. This includes cognitive behavioral therapy or CBT, psychotherapy, talking therapy, online therapy, and more.
Lastly, prescription costs for mental health treatment can be covered by health insurance. This includes the cost of detoxing from existing prescription medications and addiction treatment for substance use disorder.
Group Treatment Policies for Health Care Providers
Group and relationship therapy, such as couples therapy, marriage counseling, and family therapy, can be covered by health insurance. As with individual treatment, a mental health disorder diagnosis is required to submit an insurance claim.
Not all are willing to receive a mental health disorder diagnosis to receive mental healthcare coverage. Some may prefer to pay out-of-pocket rather than receive a diagnosis on their permanent medical record.
Therapy Coverage by Major Healthcare Providers
Let’s take a quick look at some examples of private therapy coverage. If you already have a health insurance policy at one or more of these companies, you may be eligible to receive healthcare coverage for your mental health treatment.
As with every other healthcare provider under the Affordable Care Act, United Healthcare provides mental health coverage in the same manner as any other treatment. The insurance company must cover the cost of mental health treatment if there is a diagnosis of a mental health disorder.
Health insurance from the Kaiser Foundation provides treatment plans for mental health that are personally tailored to your needs.
Coverage includes options for mental health classes, group therapy, one-on-one therapy, personalized stress management, addiction counseling, and more under the umbrella of treating a mental health disorder.
Blue Cross Blue Shield
Blue Cross Blue Shield plans before the passage of the Affordable Care Act of 2014 may not include therapy in their coverage.
However, most plans by this provider include mental health coverage. This includes psychoanalysis and evidence-based approaches to therapy.
Finding the Right Therapy Provider for You
It’s important to find the therapist or mental health care professional that meets your needs. There are two main options for starting your search.
Review your Provider’s Network
The first option is to review the list of providers included in the network of your health care provider’s coverage plan. Not all clinics and professionals may be included in your health insurance coverage, and not all mental health centers cover the same treatments.
This option will allow you to review mental health resources in your area and beyond, and you won’t have to spend time checking with each professional to ensure in-network coverage.
Check with Therapy Organizations in Your Area
The second option is to search for mental healthcare providers in your area and review their insurance coverage in your network. If you are uninsured or considering a change in insurance policies, this will allow you to find new providers outside your network.
For online searches, an online database of inexpensive therapists is available through the Open Path Psychotherapy Collective. This is a network of therapists that seek to provide low-cost treatment to patients at any level of healthcare coverage.
A similar online database of psychologists is available through the American Psychological Association, and you can find a public database of psychiatrists through the American Psychiatric Association.
Budgeting and Rates of Different Healthcare Professionals
When searching for mental healthcare services that are covered by your insurance policy, remember that rates can vary between professionals. A therapist may charge different rates than a social worker, psychiatrist, or psychologist.
Therapy can be expensive, and professionals are aware of this. Many therapists offer services at vastly reduced costs; others will accept an adjustable rate of pay that fits your budget. There is mental health treatment available at all budget levels.
In general, digital services are less expensive than traditional ones. Therapy text chat apps like Talkspace allow you to connect immediately with a therapist through the internet. Online therapy can be as helpful as meeting a therapist in person, but this is not always the case.
Combining digital with in-person treatment and sliding scale payment plans can greatly reduce your treatment cost. Additionally, many private health insurance providers include their own online mental healthcare services.
Under the passage of the Affordable Care Act of 2014, healthcare providers are required to treat mental health coverage in the same way as any other illness. A mental health diagnosis is needed to receive coverage.
The primary cost covered is emergency and inpatient treatment for patients spending time in hospitals. Outpatient and preventative treatments are secondary and only covered by more advanced plans. Coverage for prescription costs is also often included as a separate part of most health insurance plans.
If private healthcare is out of reach, mental healthcare treatment is still available through Medicare and Medicaid programs under the Affordable Care Act. Additionally, some organizations provide mental health treatment at a low cost.
Ultimately, if you are seeking coverage for mental health treatment, you will need a private or public healthcare insurance policy. You will also need an official mental disorder diagnosis to file an insurance claim.
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