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Understanding Mental Health Insurance Coverage : Options and Treatment Types

  1. Introduction

    1.1 Mental Health and Insurance

    Over the years mental health issues have been on the rise especially since the outbreak of COVID where people were largely confined to their homes. During this time there were increased number of mental health cases of which anxiety and depression were the most common. However, mental illness is not restricted to only these two conditions.[1]

    There are a host of other mental conditions that a person may be dealing with. This has called for the requirement of effective and affordable mental health treatment and in fact this has become an integral part of the overall healthcare industry. As many mental health conditions are either expensive or inaccessible it requires intervention of health insurance for help.[1]

    Health Insurance can play a pivotal role in making mental health treatment not only accessible to many people but also make it more affordable. It can do this by covering the costs of therapies and counseling sessions.[1]

    1.2 Purpose of This Article

    The purpose of this article is to discuss the options available for people with regard to insurance coverage for mental health treatment, the different types of condition that are covered by insurance, what the law says, and what the ways to find a mental health provider a specific insurance plan.

    By the end of this article the reader is expected to have a precise knowledge about how to proceed with regard to insurance coverage for mental illness.

  2. Types of Mental Health Treatment Covered by Insurance

    2.1 Explanation of the Different Types of Mental Health Treatment That are Typically Covered by Health Insurance Such as Therapy and Counseling

    Health Insurance companies cover various types of mental health treatment strategies like counseling or therapy sessions. A therapy session is basically a talk session where the patient discusses with the mental health professional about how he feels, the issues that he is facing, and his past, and based on that the treatment provider devises a treatment plan. Counseling is quite similar to therapy sessions but are designed to cater to specific issues like relationship, stress, grief, and career related problems.[2]

    2.2 Discussion of the Different Types of Mental Health Professionals that Provide These Services, such as Psychiatrists, Psychologists, and Licensed Clinical Social Workers

    There are basically three types of mental health professionals, namely psychiatrists, psychologists and clinical social workers. While a psychologist does the counseling sessions, the psychiatrist prescribes medications to control the symptoms. Clinical social workers are also qualified to provide counseling and therapy services.[2]

  3. How Mental Health Treatment is Covered by Insurance

    3.1 Explanation of How Mental Health Treatment is Covered by Health Insurance Plans, Including Co-Payments, Deductibles, and Coinsurance

    Every insurance company has its own insurance plans covering majority of the illnesses. As is the case with other medical conditions, the insurance coverage for mental health treatment depends on the plan chosen by a person.[3]

    However, what is different in mental health treatment when compared to other illnesses is that the deductibles and co-pays may be applied. A co-pay is defined as a fixed amount that the patient has to pay at the time of getting the service of a psychologist or a psychiatrist.[3]

    A deductible is the amount that a person has to pay the insurance company at the time of taking up a plan to cover the cost of the treatments. Coinsurance is a percentage of the amount to be paid by the patient apart from the deductibles for the cost of the treatment.[3]

    3.2 Discussion of the Differences Between In-Network and Out-of-Network Providers and How They Affect Coverage

    In-network providers are those healthcare professionals that have a contract with a person’s insurance company while out of network providers are those that are not in contract with the person’s insurance company.[4]

    If a person goes to an in-network provider then the out-of-pocket expense is considerably less when compared to going to an out of network provider and moreover in-network provider provide more wider coverage than out-network providers.[4]

  4. Mental Health Parity Laws

    4.1 Explanation of The Mental Health Parity and Addiction Equity Act and How They Require Health Insurance Plans to Cover Mental Health Treatment in the Same Way They Cover Physical Health Treatment

    Mental Health Parity Law clearly instructs the insurance company to provide the same coverage for mental health patients that they provide for patients for physical health treatment. The law ensures that there is no discrimination between people with regard to treatment and that mental health becomes affordable and accessible to everyone.[5]

    4.2 Discussion of How to Determine if your Health Insurance Plan is Subject to Mental Health Parity Laws

    Before taking up an insurance plan it is best to read the documents thoroughly and ensuring that the insurance company comes under the parity laws. The person can also directly call the insurance company and ask about whether they come under parity laws or not. Mental Health Parity Laws apply to Majority of Employer-Sponsored Health Plans, Individual Health Insurance Plans, Medicaid, and Medicare.[5]

  5. Coverage for Specific Mental Health Conditions

    5.1 Overview of How Health Insurance Covers Specific Mental Health Conditions such as Depression, Anxiety, and Substance Use Disorders

    There are different types of mental health conditions and every condition has its own treatment protocol. This can impact insurance coverage as well. It may not always be that all mental conditions and all types of treatments may be covered by the insurance companies and additionally the coverage may also be based on the severity of the condition. As an example, some insurance companies may even cover in hospital expenses for patients with severe forms of bipolar disorder or schizophrenia.[6]

    With regard to specific mental health condition insurance companies generally cover treatment for common conditions like anxiety and depression to include cognitive behavioral therapy, medications, group therapy sessions, and counseling.[6]

    5.2 Explanation of How Coverage for these Conditions May Differ from Coverage for Other Mental Health Conditions

    Insurance coverage for specific mental health conditions may differ from one insurance company to other and the plan a person chooses. As an example, some insurance companies may only limit a specific number of therapy sessions that a person can go to or in some instances may not even provide coverage for certain therapies.[6]

    Additionally, some insurance companies may ask for prior hospitalization in case a person requires hospitalization or medications for severe mental health issues like schizophrenia.[6]

    Thus, it is extremely essential to read the document of the insurance plan very carefully and make a note of which treatments are covered and which are not. Some insurance companies ask for a formal diagnosis from a mental health professional for a specific mental health condition before providing coverage for the treatment.[6]

  6. How to Find a Mental Health Provider?

    6.1 Suggestions For How To Find A Mental Health Provider Who Is Covered by Your Insurance Plan

    Sometimes it may become difficult to find a mental health provider that is covered by the insurance plan that a person has. In such instances it is best to call the insurance companies directly and ask the about their in-network mental health providers.[7]

    The document provided at the time of taking the insurance plan also will have a list of coverage providers through which a person can choose. Additionally, a referral can be made by the primary care provider of a person at high request to a mental health provider that is covered by the insurance plan.[7]

    6.2 Discussion of How to Choose a Mental Health Provider Who Meets Your Needs and Preferences

    In order for mental health treatment to be effective it is crucial to choose the right provider who can understand your needs and preferences and devise a treatment strategy accordingly. Before choosing mental health provider there are certain points that should be touched upon.[7]

    Treatment Approach: It is important to have a knowledge about the treatment approach that will be taken by the provider to treat the condition and whether the person is comfortable with that approach.[7]

    As an example, some providers may just do counseling while other may do counseling as well as cognitive behavioral therapy. It is for the patient to decide as to which treatment approach would be best for him or her.[7]

    Specialization: If a person has a specific mental health condition, then it will be more effective to choose a provider that specializes in treating that condition.[7]

    Location and Accessibility: The location of the provider and how accessible he or she is also is quite important when choosing a mental health provider that comes under your insurance plan.[7]

  7. Conclusion

    In conclusion, it is absolutely essential for a person with mental health issues to have the best treatment possible in an affordable manner for their overall good health and well-being. Health insurance therefore can play a major role in making mental health treatment affordable and accessible to everyone.[1, 2]

    However, it is important to understand that the health coverage for mental health is variable and despite the parity laws there will be some amount of co-pay and out of pocket expense which the patient will have to bear.[5]

    It is best to go through the insurance document and discuss in detail with the insurance provider as to which treatments and conditions are covered and which are not so that the best possible treatment can be provided without any excessive cost burden.[5]


Team PainAssist
Team PainAssist
Written, Edited or Reviewed By: Team PainAssist, Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:March 31, 2023

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