Finding Mental Health Services You Can Afford

The Ins & Outs of Mental Health Coverage

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You’re struggling more than you want to with a psychological problem – be it anxiety, ups and downs in mood, eating issues, or addictions – and there is no question that you are ready to talk to ​a mental health professional about it.

But you may have questions about what it’s going to cost you.

Don’t all health insurance plans include coverage for mental health services? Isn’t that what the mental health parity law means for my coverage?

Unfortunately, not all health insurance plans include coverage for mental health services. The mental health parity law, passed in 2008, required coverage of services for mental health (including substance use disorders) to be comparable to physical health coverage by an insurer. This means that your insurance company must treat financial requirements equally if your plan includes both physical and mental health coverage. If your plan does not provide coverage for mental health services, then parity would not apply.

How do I know if my health insurance covers mental health? If it does, what else do I need to know?

The description of your plan’s benefits will indicate whether or not mental health services are included. Sometimes these services are referred to as behavioral health services.

If mental health services are covered, you will need to figure out exactly what that means for your plan.

  • What is in-network coverage? Some plans offer only in-network coverage. This means that you may see a clinician who is on the insurance company’s list of providers and that you will only be responsible for making a copayment on the session.
  • What is a copay? A copayment, commonly called a ‘copay’ for short, is a charge that your insurer requires you to pay out of pocket for a specific service. For example, you may have a copay of $25 per session; this would mean that you would pay that amount at each office visit, and that your insurance company would be billed for the remainder of the fee by your provider.
  • What is out-of-network coverage? Some plans will reimburse you for services that you receive from a clinician who is not on their in-network list. This is referred to as out-of-network coverage. Typically, in this case, you would be responsible for meeting a certain deductible after which you can be reimbursed for a fixed percentage of the fee per session.
  • What is a deductible? A deductible is the amount you must pay out-of-pocket before your health insurer makes any payments. If you have $1000 deductible and your therapist charges $200 per session, then your insurer would not start reimbursing you until after you had attended, paid for, and submitted the paperwork for five sessions. If your plan reimburses you at a rate of 80% per session after meeting the deductible, then starting at session six, you would receive $160 back per session going forward (meaning that ultimately, you would be responsible for paying $40 per session).
  • How does payment work for out-of-network services? Typically, an out-of-network specialist will require that you pay for services, in their entirety, out-of-pocket. You will be provided with an invoice for all services. It is then your responsibility to submit that invoice and an insurance claim form to your insurer. This allows the insurer to track when you’ve met your deductible, and when to mail you the reimbursement checks to which you are entitled depending on your plan. [You can of course speak with your provider about the possibility of setting up a different arrangement.]

    Health insurance coverage is a tricky thing to navigate. The terms used by the insurance company may be unfamiliar to you, and your benefits may change if your employer makes a change in the type of insurance they carry. If you have difficulty understanding anything about your mental health coverage, contact the insurance company with your questions or direct questions to your employer’s human resources department. Pay careful attention when you receive a notice from your employer about your health insurance or when you receive mail from the insurer directly.

    Why doesn’t my mental health provider accept insurance?

    Mental health providers can choose whether or not to become a part of an insurance panel (i.e., an in-network provider). A provider may choose not to accept insurance for any number of reasons, including the low rates at which some insurers will reimburse the provider for their services. As a result, some plans have difficulty attracting mental health providers to participate in their network.

    To find a provider who does accept your insurance, you can look at the in-network options. Consider speaking with a clinician who you trust to see if they know any of the professionals listed. Because psychologists and psychiatrists are amongst the providers who may not accept insurance, you might also research other types of mental health providers who are more likely to be covered. If your plan will reimburse for out-of-network coverage, do the math to see if this is a way to afford seeing the clinician of your choice.

    I don’t have health insurance, or my plan does not cover mental health services. What are my options?

    Even if you are uninsured in terms of mental health services, there are still treatment options to explore.

    Look into your local academic medical centers, which may have affiliated research institutes, like this one, where individuals who are eligible for the research can receive treatment at no cost. Some employers will also offer short-term help or guidance through an Employee Assistance Program. Universities also commonly offer low- or no-fee treatment for students through a campus counseling center

    Most academic medical centers also have training programs where trainees, such as psychiatry residents or psychology interns, provide low- or no-fee treatment. Universities with schools of social work or those offering advanced degrees in psychology are also likely to have a training clinic. In some cities, group private practices also work within this model, with trainees available to provide sliding scale services. Remember that if you agree to be in treatment with a trainee, your case will receive extra attention by an expert supervisor. 

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