Mental and Emotional Health
Summary
Our mental and emotional health is a vital part of our well-being. If we don’t get the help we need, mental and emotional health problems can hurt our relationships with our family and friends, our jobs and even our communities. Those health problems may include depression, anxiety, bipolar disorder, schizophrenia, drug and alcohol abuse and attention deficit disorder, among others.
The Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 requires most plans that cover mental health to offer the same level of coverage for such health problems as they do for medical conditions. That includes costs like copays, deductibles and coinsurance, as well as treatment limits. Those limits may include number of visits, inpatient days of coverage and how often you can get treatment.
Does your plan include mental health services and cover out-of-network medical care? Then, it must also cover out-of-network mental healthcare. But, you may still need to follow plan rules to avoid high out-of-pocket costs. Those rules may include having your insurer approve services in advance, or getting a referral from your primary care physician (PCP).
Before getting mental healthcare:
- Find out what your plan covers. Find out whether there are any limits or restrictions. See how much you may have to pay for care in and outside of your plan’s network.
- Ask if you need a referral from your PCP before seeking mental health or substance abuse treatment. Ask if you need pre-approval from your plan.
Once you start treatment, keep track of your visits and inpatient days. That way, you’ll know when you are close to reaching your plan’s limits.
Coverage for Mental Health and Substance Abuse Care
Most large employers cover mental health and alcohol and drug abuse services under their employee group health plan. But, each plan may cover them differently. Some plans may limit coverage, for example, by allowing only 25 therapy visits each year, or seven days of inpatient care each year.
It’s important to know what your plan covers, because after you reach these limits, you may have to pay the full cost of these services. Review your plan’s coverage carefully, and if you have any questions, don’t hesitate to contact your plan’s member services representatives for help.
If You Aren’t Covered for Mental Health Care
If you are uninsured or if your plan doesn’t cover mental health and substance abuse care, you will have to pay the full cost yourself. Let your provider know up front, and ask if you can negotiate the cost. You may want to ask whether you can pay for your treatment in installments. Of course, your providers don’t have to accept a lower price or installment payments for their services, but it doesn’t hurt to ask.
There are organizations and federal and state agencies that may be able to help you get the care you need at a lower cost, or even for free. We’ve listed some resources in your Action Plan.
Your Action Plan: Put Mind Over Matter
Understanding the mental health services your plan covers, and what rules you need to follow, will help you get the care you need and avoid any surprises or treatment denials.
Know Your Coverage
- Before you start treatment, find out whether your plan covers mental health and substance abuse services (behavioral health services), what the limits are, and how much you may have to pay. Review your plan documents. If you have any questions, contact a member services representative at your plan. You can find the contact number on the back of your insurance ID card. Ask your plan representative the questions listed above.
- Once you start treatment, keep track of your visits and inpatient days so you know when you are close to reaching your plan’s limits and you don’t get surprised by a bill.
- If your plan does not cover mental health and substance abuse, or if you decide to go out of your network for care, use our FH Medical Cost Lookup to get an idea of how much you might have to pay.
- Understand your rights to mental health parity. You can learn more about mental health parity from the Department of Labor.
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If you have questions about how parity laws may apply to your coverage, ask your employer’s human resources administrator. You also can contact the following agencies:
- If you are covered by an employer-funded plan: visit Department of Labor online or call 1-866-444-3272. (If you are not sure whether your plan is employer-funded, ask your employer’s human resources representative.)
- If you are covered by a state, local government or church plan, contact: Department of Health and Human Services at 1-877-267-2323 extension 6-5511 or your state insurance commissioner.
Get the Care You Need
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To find mental health services near you:
- Ask your primary care provider for a recommendation or referral
- Ask your insurance plan for a list of covered providers.
- Call SAMHSA’s treatment referral service at 1-800-662-HELP (4357) or visit the SAMHSA Mental Health Treatment Locator.
- Use the American Medical Association Doctor Finder or contact the American Psychiatric Association District Branch in your state.
- Contact your state medical association. A list of state medical associations is available here.
- To find low-cost care or community services, visit the Health Resources and Services Administration website, or contact your local public health department.
More Resources
- Education and support for mental health issues
- If you need help understanding your rights, or appealing a claim denial
- Professional Associations for Mental Health and Substance Abuse Treatment Providers