Shortcut Navigation:

Mental Health Benefits

When you think of health insurance, you probably think of coverage for prescription drugs, visits to the doctor, hospital stays, surgery expenses, and the like. But your overall health also includes your mental health, so don't overlook benefits that can help your outlook. Depending on the type of health insurance plan you have, coverage for mental health expenses may or may not be included. Review your policy with an eye for the following.

What are mental health expenses?

Depression, anxiety, and other mental disorders affect countless Americans. So do substance abuse problems. Treatment for these problems may include consultations with doctors, private counseling, group therapy, prescription medications, hospital stays, outpatient programs, alternative living arrangements, and other expenses.

Read your health insurance policy to determine whether mental health benefits are provided

Whether you have a private health insurance plan or participate in a group health plan at work, you'll need to read your policy carefully to find out what is and isn't covered. If your policy provides coverage for mental health care, consider the extent of that care.What types of benefits are provided? What do you have to do to get benefits, and how do you appeal decisions you don't agree with? There could be a different set of procedures for mental health care than for other forms of medical treatment in your plan. You should also pay close attention to treatments that are excluded from coverage and any limitations (e.g., hospitalization coverage for a maximum of 14 days).

Pay close attention to the types of mental health care providers and the approval process

Find out which mental health professionals are covered by your plan. Are social workers, clinical psychologists, and psychiatrists included? What if you choose a licensed professional not covered by the plan? Some plans will deny coverage if you go outside their network of providers.

You should also determine who'll make the decision regarding the type of treatment you'll need. You may need to speak with your primary care physician (PCP) or call a toll-free number to explain your situation. Must you get approval before seeing a mental health specialist? Find out how long it takes to receive approval for treatments, and whether your mental health care provider will have to request approval for subsequent treatments.

Continuity and coordination of your behavioral health and medical care are important, so it is to your advantage to include your PCP in your treatment for mental health issues. If your policy does not use the same network of providers for mental health and medical care, make sure that your physicians share information in order to carefully monitor medication usage.

In addition, look to your policy to determine how your privacy will be protected. For example, if your medical information is transmitted, stored, or used for any purpose as data, will anything that identifies you be removed to protect your privacy? Will the information be transferred to others or sold? If your policy is unclear or fails to address important issues, ask your insurance agent.

Group health insurance plans and mental health

Group health insurance plans are usually not required to include mental health coverage. However, some states do have laws that mandate this type of coverage. If your plan provides this type of coverage, federal law prevents the plan from placing annual or lifetime dollar limits on mental health benefits that are lower than the limits for medical and surgical benefits. For example, if your health plan has a $1 million lifetime limit on medical and surgical benefits, it cannot put a $100,000 lifetime limit on mental health benefits. (This law does not apply to individual health insurance plans or to groups with fewer than 50 employees.) Some states have their own additional requirements.

Group health plans may put other restrictions on mental health benefits and still comply with the law. For instance, mental health benefits can have higher co-payments or a lower number of allowed treatments, as compared to medical and surgical benefits.

What to do if you need help

If you're concerned that you're suffering from a mental disorder, be aware that physical conditions may be causing your symptoms. Behavioral disorders can have a medical basis or implications for your physical health. Your PCP can help determine if your symptoms are related to a medical cause. Medically related causes for mental or behavioral disorders will be covered under your medical care policy.

Follow your policy's guidelines to get help. If your policy does not cover mental health benefits, check with your state department of public health for any publicly funded programs where you may be able to receive services for substance abuse or mental health. Also, many employers provide on-site counseling or reimburse external agencies to provide the service for their employees under their employee assistance program.

Many states require insurance carriers to provide mental health benefits, so find out if your state mandates behavioral health and substance abuse benefits. Be sure to take notes and get the full names of anyone you speak to at your insurance company. If you don't follow the insurance company's rules, you could have to pay for the appointment yourself.