The Pros and Cons of Using Health Insurance for Mental Health Care
Mental health care services are an important part of holistic health. According to the Anxiety and Depression Association of America, nearly one in five Americans live with an anxiety disorder and 16 million adults in the United States live with depression. These conditions are associated with more doctor’s office and hospital visits, increased risk of heart attack and a weakened immune system.
The good news is that if you have an ACA compliant health insurance plan, then your health insurance covers mental health care. This removes a significant roadblock to treatment, which can be pricey. The bad news is that using your health insurance to cover mental health services may be more difficult than you would expect.
Benefits of Using Health Insurance for Mental Health Services
Reduced Medication Costs
Many people living with mental health disorders benefit from prescription drug therapy. Even if you pay for your therapy sessions out of pocket, your health insurance policy still covers prescription medications. If you aren’t asked to pay a copay for the visit, you should only have to pay a discounted “network” rate, instead of the full normal rate.
Pre-existing Conditions Do Not Affect Coverage
Even if you were diagnosed with a condition like bipolar disorder or generalized anxiety disorder decades ago, your health insurance provider cannot deny you coverage for treatment. Under the ACA, pre-existing conditions must be covered.
Our recommendation is to make sure you are seeing contracted providers if possible. If you have an HMO, you won’t really have a choice because the HMO requires you to use their providers. If you want to see a specific therapist, and they are not in your plans network, you must pay the full cost yourself.
Drawbacks of Using Health Insurance for Mental Health Services
Lack of Long-Term Documentation Privacy
Any documented health treatment that you receive (that is filed through your health insurance company) becomes part of your permanent medical file. If your health insurance company audited your records to prevent fraud, they would have access to all the details about what was discussed in each counseling session. This lack of privacy makes therapists hesitant to accept health insurance, and patients hesitant to file claims.
Difficulty Finding a Therapist
Health insurance companies and therapists have a difficult relationship, and in most cases, working with health insurance companies results in therapists receiving less money and taking on a lot more administrative work. For this reason, many therapists do not accept health insurance. Those that do, typically have very long wait times, which may not be practical when dealing with a mental health issue. We currently have a shortage of mental health providers here in Nevada, which only compounds the problem.
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The Requirement for a Specific Diagnosis
In most cases, health insurance companies only cover medically necessary services, which require a specific diagnosis. However, many people seek mental health services for reasons not defined by a specific mental health condition. Unless you are receiving mental health services for a particular disorder like bipolar or schizophrenia, you may have a hard time getting your health insurance to cover your sessions. Call your insurance plan for details on what mental health services are actually covered.
How Your Health Insurance Policy Handles Mental Health Services
When it comes to your well-being and quality of life, mental health is just as important as physical health. Unfortunately, only about 40% of people who need mental health services get treatment. One of the biggest roadblocks to treatment is that many believe that getting help from a mental health professional would be too costly. At one point, that was probably true. However, because of a 2008 law called the mental health parity law, health insurance companies must provide mental health coverage that is comparable to physical health coverage.
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What Does the Mental Health Parity Law Guarantee?
The mental health parity law requires that health insurance companies treat financial requirements equally. For example, if you have a $20 copay for visits to your primary care doctor, your health insurance company must charge a comparable copay for office visits with a mental health professional. On top of that, your health insurance company can’t limit how many times per year you see a mental health professional, as long as those visits are deemed a “medical necessity.”
Does This Law Apply to Your Health Insurance Plan?
In most cases, the mental health parity law applies to major medical plans, including:
- NV Medicaid
- Employer-sponsored health insurance
- Children’s Health Insurance Program (CHIP)
- Health insurance purchased through Nevada Health Link
To find out how your health insurance plan covers mental health services, check your description of plan benefits. A health insurance agent can also help you understand exactly what your plan covers.
How to Find Supportive Services
In addition to professional counseling services, you may benefit from connecting with local supportive services in your community.
Support Groups
Meeting with others and sharing experiences and coping mechanisms can be beneficial for those living with conditions like depression. Oftentimes, support groups meet in local churches, schools and government buildings. In some cases, support groups have online meetings in chat rooms or on discussion forums, which may appeal to you if you prefer anonymity.
Hotlines and Warmlines
Hotlines and warmlines provide immediate help over the phone for people with mental health conditions. Hotlines are typically for crisis intervention while warmlines provide comfort and referral services, and both are easily accessible no matter where you live.
Drop-In Centers
Peer-run drop-in centers are safe places to go for comfort and support. While they typically serve as informal gathering sites, in some cases, these centers organize activities like support groups and educational workshops.
Find Mental Health Coverage with Nevada Insurance Enrollment
Understanding your health insurance policy is vital for receiving the physical and mental healthcare you need without racking up huge medical bills. Different health insurance plans have different coverage options, so if you need mental health services, there is a plan for you. One of our friendly and knowledgeable health insurance agent can help you review your current policy or find a plan that meets your needs.
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