Our mental health is a vital part of our overall well-being. It affects how we think, how we feel, and how we act. That’s why it’s important to take our mental and emotional health as seriously as our physical well-being. If we don’t get the help we need, conditions like depression, anxiety, bipolar disorder, schizophrenia, drug and alcohol abuse, and attention deficit disorder can hurt our relationships with our family and friends, our jobs and even our communities.
To make sure you’re getting the care that’s right for you, it’s a good idea to understand the types of professionals who provide mental health services, what type of care your plan covers, and how mental health parity laws may affect your coverage.
Who Provides Mental Health Care?
Mental health and substance abuse services (also known as behavioral health services) are provided by many different types of healthcare professionals in a variety of settings, from offices to hospitals. These professionals have different levels of education, experience and training. The differences can often affect the cost of services, and the type of treatments and providers your plan covers.
Some types of providers you may see are:
General practitioners, neurologists, internists and family practitioners, who often encounter patients with mental health needs, also can prescribe medications for mental and behavioral health issues. They can refer patients to mental health professionals.
You can find more about the different types of mental health professionals in the list of professional associations/societies that we’ve included in your Action Plan.
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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 7 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.
What is Mental Health and Substance Abuse Parity?
The Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 requires most plans to provide “parity” for mental health and substance abuse services. This means plans that cover mental health must offer the same level of coverage for these conditions that they do for medical conditions. That includes the members’ share of costs (such as co-pays, deductibles, co-insurance and out-of-pocket expenses) and treatment limits (like the number of visits, inpatient days of coverage and how often you can get treatment). And, if a plan includes mental health services and covers out-of-network medical care, it must also cover out-of-network mental health care.
Not all plans are covered by the law. The mental health parity requirements only apply to large group health plans (covering 51 or more employees) that offer mental health coverage and are also state-funded, employer-funded, or managed-care Medicaid programs. Some states have added extra parity requirements that apply to smaller plans. If you aren’t sure whether your plan is covered, check your plan description or your insurer’s website, or call a member services representative.
In 2014, the health reform law will require more plans to meet parity rules, like plans in the new state health insurance exchanges that cover 50 people or less and additional Medicaid groups. Qualified plans on exchanges also must offer basic coverage for some mental health and substance abuse services. States can require plans on exchanges to cover more services in addition to the basic requirements, but states will have to pay for any extra costs that the plans may incur as a result.
How Do I Get the Care I Need?
Start With Your Health Plan
Before you get care, find out if your plan covers the services you’ll need. Read your plan documents carefully, and if you have any questions, contact a member services representative. You can usually find the number on the back of your insurance ID card. You may want to ask:
If You Go Out-of-Network: Keep in mind that you may pay more for out-of-network care than for in-network care. If you decide to go out-of-network, make sure you know how much of the cost your plan will pay. You can also use our FH Medical Cost Lookup to get an idea of how much you may owe.
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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.
In an Emergency
If you need help right away, dial 911 or the National Suicide Prevention Lifeline (800 273-TALK), a free 24-hour service. The Lifeline website also has information about care. For substance abuse issues, you may call 1-(800) 662-HELP, a federal hotline. You also may choose to contact your provider and/or go to the ER.
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
o If you are covered by an employer-funded plan:
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.)
o 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
o Ask your primary care provider for a recommendation or referral.
o Ask your insurance plan for a list of covered providers.
o Call SAMHSA’s treatment referral service at 1-800-662-HELP (4357) or visit the SAMHSA Mental Health Treatment Locator.
o Use the American Medical Association Doctor Finder or contact the American Psychiatric Association District Branch in your state.
o Contact your state medical association. A list of state medical associations is available here.
o To find low-cost care or community services, visit the Health Resources and Services Administration website, or contact your local public health department.