Your Costs

Looking Up Costs for Behavioral Health Services

Summary

To look up the estimated costs for behavioral health services (including mental health and alcohol and/or drug services), go to our home page, fairhealthconsumer.org, and click on Medical and Hospital Costs. You’ll see the menu choice “Behavioral Health (including Alcohol and/or Drug Services).” If you click on that, you’ll get this menu of choices:

  • Psychiatry services. Psychiatrists are doctors who are trained to diagnose and treat the mental and physical aspects of behavioral health disorders.
  • Psychotherapy. Psychotherapy is the use of talk with a trained provider to treat behavioral health problems.
  • Inpatient/outpatient rehabilitation. Rehabilitation helps people with mental health or substance abuse issues be restored to health. The services can be given while the patient lives in a treatment facility (inpatient). Or they can be given while the patient lives at home (outpatient).
  • Behavioral support services. These include, for example, activity therapy (such as music and dance) as part of mental health treatment.
  • Adaptive and health behavior services. Adaptive behavior services help patients with autism and other disorders improve social, communication, self-care and other skills. Health behavior services give psychological help to patients dealing with physical health problems.

The results page for the service you choose will show you two main results. These are out-of-network/uninsured and in-network prices. The out-of-network/uninsured price is an estimate of how much you’ll have to pay if you lack health insurance. It’s also what you may have to pay if you have insurance but the doctors, hospitals or other providers caring for you aren’t in your health plan’s network. The in-network price is an estimate of what the costs will be if you have health insurance. That includes both your insurer’s share of the cost and your share.

If you want to know the typical costs for behavioral health services, our website can help. Behavioral health services include mental health and alcohol and/or drug services.

To look up the estimated costs for behavioral health services, go to our home page, fairhealthconsumer.org, and click on Medical and Hospital Costs. You’ll see the menu choice “Behavioral Health (including Alcohol and/or Drug Services).” If you click on that, you’ll get the following menu of choices.

Psychiatry services. Psychiatrists are doctors who are trained to diagnose and treat the mental and physical aspects of behavioral health disorders. In the category of psychiatry services, you can choose from among:

  • Evaluations. These are assessments of a patient’s health. For example, they include a psychiatric diagnostic evaluation and an alcohol and/or drug assessment.
  • Psychiatric and neuropsychiatric services. This category relates care of behavioral health problems to care of the brain. One example is using a magnetic field to stimulate nerve cells in the brain. Another example is using electricity to stimulate the brain.
  • Other services. This category includes a variety of services, such as management of prescriptions and guided hypnosis.

Psychotherapy. Psychotherapy is the use of talk with a trained provider to treat behavioral health problems. In this category, you can choose from among:

  • Individual. These services are for one-on-one psychotherapy between the patient and provider.
  • Group. In these services, the provider meets with a small group of patients.
  • Family. In these services, the provider meets with a family.

Inpatient/outpatient rehabilitation. Rehabilitation helps people with mental health or substance abuse issues be restored to health. The services can be given while the patient lives in a treatment facility, such as a hospital (inpatient). Or they can be given while the patient lives at home (outpatient). In this category, you can choose from among:

  • Hospital-based. These services are given in a hospital, whether the patient is living there or living at home.
  • Residential treatment programs. These services are given in a residential (live-in) treatment center other than a hospital.
  • Other rehab-related services. These are other services related to rehabilitation. An example is treatment with methadone, a drug used to treat opioid use disorder.

Behavioral support services. These refer to other services related to supporting behavioral health. They include, for example, activity therapy (such as music and dance) as part of mental health treatment.

Adaptive and health behavior services. Adaptive behavior services help patients with autism and other disorders improve social, communication, self-care and other skills. Health behavior services give psychological help to patients dealing with physical health problems.

  • Assessment. These are services that involve making judgments about health, such as assessment of health behavior.
  • Treatments and intervention. These are services that offer adaptive and health behavior treatment.
    • Individual. These services are one-on-one between patient and provider, such as adaptive behavior treatment.
    • Group. In these services, the provider meets with a small group of patients.
    • Family. In these services, the provider meets with a family.

Each of the services under these categories has its own code. The code consists of five numbers or a combination of letters and numbers. For more information on codes, see this Insurance Basics article.

Out-of-Network/Uninsured and In-Network Costs

The results page for the service you choose will show you two main results. These are out-of-network/uninsured and in-network prices.

The out-of-network/uninsured price is an estimate of how much you’ll have to pay if you lack health insurance. It’s also what you may have to pay if you have insurance but the doctors, hospitals or other providers caring for you aren’t in your health plan’s network. Some plans will pay something for such care, which is called “out-of-network,” but others don’t. Check your plan documents or call your member services representative for the out-of-network benefits, if any, associated with your plan. Out-of-network providers don’t have a contracted rate with your health plan, so you’ll likely pay more if you go to them.

The in-network price is an estimate of what the costs will be if you have health insurance. That includes both your insurer’s share of the cost and your share. In-network providers are doctors, hospitals and other providers who have agreed to take your insurance plan’s contracted rate for their services. Your share of the cost is determined by your health plan’s terms and conditions. It may be in the form of a copay, coinsurance or deductible. Copays are a set amount for a service, like $20 for a doctor’s visit. Coinsurance is a percentage of the cost, such as 15 percent of the in-network price. A deductible is a set amount you have to pay each year before your plan starts paying for your care.

How to Use Your Cost Estimates

If you have health insurance, getting a cost estimate will help you to budget and plan for the costs. It’s especially useful to get an estimate if you have a high-deductible health plan. That’s a plan that won’t pay for your care until you’ve already paid a high amount. Even if you’re using in-network doctors, you’ll want to know the in-network costs. That’s because you’ll have to pay the costs in full until you pay off the deductible.

Are you thinking about using out-of-network services? If so, an estimate will help you grasp the difference between your in-network and out-of-network share of costs. If you decide to go out of network, the estimate will help you to negotiate a price with the out-of-network providers. If you’re uninsured, having an estimate will help you to negotiate a price with any healthcare providers for their services and also allow you to see the potential benefits of coverage.

For more information on behavioral healthcare, see our Insurance Basics article on Mental and Emotional Health.

Your Action Plan: Looking Up Costs for Behavioral Health Services

  • On our home page, fairhealthconsumer.org, click on Medical and Hospital Costs.
  • From the menu, choose “Behavioral Health (including Alcohol and/or Drug Services).”
  • Choose from the menu of more specific options.
  • Get your cost estimates for the service you choose.

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