What you should know about insurance for mental health
Mental and physical well-being are equally crucial to our overall wellbeing. Regretfully, insurers haven't always held that opinion. Many health insurance providers used to cover physical illnesses more comprehensively than mental health conditions.
What is the function of the law?
Insurance companies are required by the federal parity statute to provide coverage for mental and behavioral health and substance use disorders on par with or better than that for medical and surgical treatment. It follows that insurers have to handle financial requirements fairly. For instance, if an insurance company only charges a $20 cost for the majority of medical/surgical office visits, it cannot charge a $40 copay for visits to mental health professionals, such as psychologists.
Which health plans are impacted by the law?
The following categories of health insurance are often covered under the federal parity law:
employer-sponsored health insurance for businesses with fifty or more workers
coverage obtained via health insurance exchanges established by the Affordable Care Act, or "Obamacare," a health care reform law
How can I find out if mental health services are covered by my health insurance plan?
Verify the benefits described in your plan description; it ought to have details on behavioral health therapies or coverage for drug and alcohol abuse disorders. Ask your human resources representative or get in touch with your insurance provider directly if you're still unsure.
There are no benefits for mental health under my insurance plan. Does that mean it's against the parity law?
Insurance companies are not required by the parity law to give mental health benefits; rather, it stipulates that if they do, the benefits cannot be subject to more stringent regulations than those that govern physical health benefits. Thankfully, before the parity rule went into force, the great majority of large group insurance offered mental health benefits. Furthermore, the Affordable Care Act mandates that services for mental health and substance-use problems be covered by plans that are made available through the health insurance exchanges.
Does the parity law apply to all disorders related to mental health?
The federal parity statute covers all diagnoses for mental health and substance use disorders covered by a health plan, unlike some state parity laws. A health plan may, however, expressly exclude some diagnoses, regardless of whether they are categorized as behavioral or mental health issues or as physical/medical issues. The description of mental health benefits in your plan should make any exclusions apparent to you. Ask your insurance provider if you have any questions.
I have mental health coverage, but my mental health practitioner won't take my insurance.
It is up to psychologists and other mental health professionals to decide whether to take insurance or not. Regretfully, in spite of the growing administrative expenses of maintaining a practice, many insurance companies have not raised the reimbursement rate for psychologists in ten or even twenty years. Reimbursement rates have recently been reduced by other companies. Consequently, mental health practitioners may find it difficult to join some plans' networks.
What must I do in order to receive payment for my psychotherapy services?
If you are seeing a mental health provider who does not take your insurance and your health plan covers out-of-network providers for mental health treatments, fill out the insurance claim form and send it in with the mental health provider's invoice to get reimbursed. Get in touch with your insurance carrier if you have questions about the out-of-network provider claim process under your health plan.
If I believe my insurance company is not abiding by the parity law, to whom should I speak?
Ask your human resources department for a summary of benefits to better understand your coverage if you are concerned that your plan isn't adhering to the parity requirement, or get in touch with your insurance provider directly. In addition to giving you details about your benefits, your HR department might be able to connect you with a health care advocate who can help you file an appeal. In order to make sure that benefits are fulfilling employee needs, your HR department may want to monitor any issues that other employees may be experiencing and collaborate with the insurance provider.
Making use of your mental health benefits
For detailed information regarding your coverage, contact your insurance provider or the human resources department. The following are some crucial things to think about: Verify whether provider networks are used by your coverage. When a patient sees an out-of-network practitioner, they usually have to pay more out of pocket. A list of in-network providers can be obtained by calling your insurance provider or by visiting their website.Inquire about copayments. A copay is the amount that you must pay out of pocket for a particular service as mandated by your insurance carrier. For example, you might have to pay $20 for each visit to the doctor. Copays for mental health visits may have previously exceeded those for the majority of medical visits. For insurance policies covered by the parity law, it ought to no longer be the case.
