If you are one of the millions of Americans who is searching for mental health treatment, then insurance coverage for the cost of care is usually a concern. To answer the question, “does insurance cover the cost of mental health treatment?”, we have to take a deeper dive into how insurance policies work. Thankfully, there’s a high chance that your policy offers some level of coverage.
In the past few years health insurance companies have responded to the demand for and the importance of mental health care by providing coverage for services. With that said, it is important to understand the differences between the benefits that insurance carriers provide and the cost that you might be responsible for.
What Should You Know About Insurance For Mental Health?
If you have health insurance coverage then it can be through a number of different types of policies. Common coverage is through the marketplace, a job, medicaid, and medicare. Regardless, the most important thing to understand is that insurance companies will only pay medically necessary services. Thus, they require a mental health diagnosis prior to paying for claims.
There are a multitude of mental health conditions that individuals can be diagnosed with. People can struggle with anything from acute stress, depression, anxiety, insomnia, or many other diagnoses. In regards to insurance, each of these diagnoses would have specific code that goes onto the insurance claim for reimbursements.
What Are The Policies For Different Types Of Insurance Coverage?
There are a number of different insurance scenarios and policies. Different rules and laws apply for different coverage. Read on to understand your benefits better depending on the type of health insurance you have.
Employer-sponsored insurance policies in businesses of 50+ employees
Businesses of fifty plus employees are mandated by law to offer health insurance to employees. These laws do not specifically address that mental health and substance abuse services must be included. Nonetheless, most large companies provide some level of counseling and therapeutic service coverage.
Employer-sponsored insurance policies in businesses with under 50 employees
Smaller companies are not required by law to offer health insurance to employees. However, many small businesses do choose to anyway. As with larger companies there is normally some level of mental health and addiction services covered under the policies.
State insurance policies, such as medicaid, are required to cover both mental health and substance abuse services. Medicaid plans and coverage vary from state to state. If you have questions regarding your plan, then contact your carrier or review your policy documents.
Medicare policies cover inpatient mental health and addiction treatment under Part A benefits. While outpatient services are covered under Part B. The exception is if you have a Medicare Advantage Plan. Costs may vary in comparison to those with original Medicare.
Health Insurance Marketplace plans
The Affordable Care Act mandates that all health insurance policies purchased through the marketplace must cover the ten essential health benefits. This includes mental health and substance abuse services. If you have a marketplace policy and are asking, “does insurance cover the cost of mental health treatment?”, then the answer is yes, at least to some extent.
All coverage offered on the marketplace includes mental health benefits. This includes individual, family, and small business plans. It is important to note that plans and the coverage they offer varies by state.
Does Insurance Cover The Cost Of Mental Health Treatment If I Have A Marketplace Plan?
All marketplace plans are required to cover the following in regards to mental health treatment:
- behavioral health treatments, such as therapy and counseling
- mental health inpatient services
- coverage for pre-existing conditions
- No dollar limitations on mental health treatment
- Certain protections so that the copays, coinsurance, and deductibles for mental health services are the same or close to those for medical and surgical benefits
Does Insurance Cover The Cost Of Mental Health Treatment? How to Check
Your health insurance plan’s website should have information about your benefits, coverage, and estimated out of pocket cost. Insurance companies normally offer a multitude of different plans, so make sure that you are logged into your member portal.
If you have to stay in-network for mental health or substance abuse treatment, then your portal should contain a list of providers. You can also contact your health insurer in order to go over the list verbally.
Ask the facility if they accept your insurance
Prior to entering into a treatment facility, an outpatient program, or seeing a counselor the admissions department or provider should run a verification of benefits. Through this process they can let you know what your out of pocket cost is, what your benefits are, and a general idea of what to expect in terms of insurance throughout your treatment process.
What kinds of treatments are normally covered by insurance?
Mental health services that are normally covered by insurance include:
- psychiatric emergency services
- co-occurring medical and behavioral health conditions, such as coexisting addiction. This is often referred to as a dual diagnosis.
- talk therapies, such as cognitive behavioral therapy
- outpatient sessions with psychiatrists, therapists, social workers, ect
- telemedicine services
- inpatient mental health treatment
- addiction treatment
- medical detox services, including medications
- medication assisted treatment
Insurance carriers will only cover treatments that are considered to be medically necessary and evidence based. Thus, certain holistic treatments may not be covered. There can also be limitations to certain coverages. For example, inpatient rehab may require prior authorization or a referral from your primary care physician.
Mental Health Treatment In Fort Lauderdale, FL
Are you struggling with your mental wellness? Are you wondering “does insurance cover the cost of mental health treatment”? Thankfully, The Healing Center provides mental health treatment in Fort Lauderdale, FL. Our admissions team will handle the complicated process of understanding your insurance coverage for you. Your main focus should be getting better. If you are ready to get the help that you need, then contact our admissions team today to get started on your healing journey.