I am currently 24 years old, and as I have transitioned into adulthood, one thing that I have yet to be able to fully understand is how health insurance works. I wrote this article as I attempted to understand mental health and how it works with my insurance.
If you were to Google “Health Insurance Horror Stories”, there are 19,600,000 results that appear. Across the world, there are different health insurance systems in different countries, and all of them have their own unique problems. Here in the United States, medical bills are the #1 cause of bankruptcy. In 2016, we spent $3.3 trillion dollars on healthcare. About 49% of Americans get their health insurance through their employer, 19% through Medicaid, 14% through Medicare, 7% through non-group plans, and 2% through public insurers. 9% of Americans are uninsured. There are over 900 health insurance companies. Trying to understand the terms “deductibles”, “out of network”, “HSA’s”, “out-of-pocket maximum”, “premiums”, and so many more can be a headache. On top of it all, understanding if mental health care is covered under your plan, and to what extent, can be a whole other headache itself.
My Personal Experience Trying to Understand Mental Health Insurance Coverage
I decided to do some research to try and understand how mental health works with health insurance and how much it might cost me to get mental health treatment. I have not done research on this before and have not received mental health treatment before. These were my findings after trying to do this for the first time.
First, I went to my healthcare website. Since I am 24, I am still on my parent’s plan, which happens to be Regence Health Care. I signed in and went to a tool that they have that allows me to find doctors near me that specialize in the treatment I am looking for. Then I found a few that were in-network that were close by so that was a good start. Next, I went to a tool that they have, which is supposed to estimate my costs. I could not find anything around mental health, counseling, or therapy, so I am unsure of what this would cost me. I can see my deductible, my annual out-of-pocket maximum but no signs of whether mental health would be covered or discounted at all through my insurance.
After searching around the website, I decided to type in “mental health” on the search bar. I got a message saying, “No Results for “Mental Health” – Check your spelling or try a more general term.” I am not sure what could be more general than mental health, so I concluded that there was nothing on my insurer’s website about my current mental health benefits. I decided to ask around and look online more to see what I could find.
What I was able to gather from researching online is the following:
- The Mental Health Parity Law was passed in 2008 and requires coverage of services for mental health, behavioral health, and substance abuse disorders. The law requires insurance companies to treat mental and behavioral health coverage equal to medical/surgical coverage. This law affects employer-sponsored health coverage, coverage through health insurance exchanges, children’s health insurance programs, and most Medicaid programs.
- The parity law does not require every insurer to have a mental health benefit plan, but that there cannot be more restrictive requirements than those that apply to physical health benefits. The Affordable care act does require that plans offered through the health insurers exchange cover services for mental health.
- There is a single deductible for physical and mental health benefits. Once your health plan deductible is met, your insurance company should reimburse you for your expenses.
- Insurance companies cannot limit the number of mental health therapy sessions per year, but they can manage your care. This means that after a certain number of visits they can evaluate your case to see if additional treatment is necessary.
- Something important to remember is that certain mental health providers do not accept insurance. Just because you have health insurance and it covers mental health treatment, does not ensure that you will be able to use it with certain providers.
Understanding Your Own Mental Health Insurance Coverage
The best path in figuring out if your mental health treatment will be covered by your insurance company is to call your mental health service provider ahead of time and check with them to see if they take your insurance. Then, check with your insurance to see if they cover mental health-related treatments and to what extent. You can ask questions like, how much will this $130 therapy session cost me after insurance? Though it may be time-consuming and sometimes frustrating, it is best to talk directly to the provider and insurer to try and understand the situation.
- Figure out which mental health providers are “in-network”. This can be done through your insurance company’s website or by calling them and asking them.
- Ask about copayments. Insurance companies require you to pay out-of-pocket copayments for certain services. Even if the treatment is covered under your plan, you may be required to pay a copay every time you visit.
- Understand your deductible and whether you have reached it or not.
- Ask the provider about their payment policy, and if they will bill the insurance company or if you need to pay in full then submit a claim.
Is cost the only thing holding you back from getting the help you need? Or maybe it is currently costing you an arm and a leg. Whatever your situation is, reach out to your health insurance company and see what benefits are available for mental health.
Ben Roberts, Director of Community
Ben enjoys helping people become their best selves and enjoys working to help solve problems around mental health to ensure that people can live fulfilling lives. He joined the Overt Foundation in April of 2019 and works to help ensure that things run smoothly and that people are getting the help they need.