Mental Health Insurance

What is mental health insurance?

Mental health insurance covers problems such as anxiety, depression, substance abuse treatment, and behavior disorders in children. Mental health coverage may be included in your medical insurance.

Most Americans get health insurance through their jobs. This is called group insurance. Group insurance is generally the least expensive kind. Employers pay part or all of the cost.

All health insurance plans do not cover mental health problems. Mental health insurance may be separate, like vision or dental plans. To check if you have mental health coverage you can:

• read your insurance policy
• call the benefits manager
• contact the human resources department where you work.

Are there different kinds?

There are different kinds of insurance plans:

• HMO (health maintenance organization): You pay a monthly premium and the HMO covers healthcare provider visits, hospital stays, emergency care, lab tests, and therapy. You must use the providers and hospitals chosen by the HMO.
• PPO (Preferred Provider Organization): You pay a monthly fee and either a co-payment or a percentage of the charges. For example, you might pay 20% while the insurance company pays 80%. When you visit the providers and hospitals that are part of the PPO, a larger part of your medical costs is covered. If you see providers who are not part of the plan you pay more.
• Fee-for-Service: This type of health insurance allows you to choose any provider or hospital you wish. You pay a monthly fee (premium); a deductible (such as $250 per person) each year before the insurance company pays anything; and coinsurance (for example, you might pay 20% while the insurance company pays 80%).

Most insurance plans have a co-payment that you pay each time you see a healthcare provider. However, your mental health copay may be different from your medical copay.

How do I use my mental health coverage?

How to use your insurance depends on which type of insurance you have. If you are part of an HMO, you usually must call the phone number on your insurance card and get approval first. Your insurance company will approve a certain number of visits (usually 1 to 10) to a mental health therapist. Most insurance companies provide a list of providers who are in their network.

If you have fee-for-service or PPO insurance, you generally do not need to contact your insurance company first. You may call a provider directly to set an appointment. The first thing you should do is read your insurance card, your benefit booklet, or call the customer service phone number on your card to ask:

• Does my insurance plan cover mental health treatment?
• What services are paid for by the plan?
• Do I need to have mental health treatment authorized ahead of time?
• Are there limits on the number of visits?
• Are there certain diagnoses or preexisting conditions that the plan does not cover?
• Is there a lifetime dollar limit or an annual limit for mental health coverage? What is it?
• Is there a preferred list of providers or network that I must use?
• What is my copay?

What if I don't have mental health insurance?

You could buy an individual policy. Before you buy any health insurance policy, make sure you know what it will and will not cover. Call insurance companies in your area or speak to the agent who handles your car or house insurance.

If you do not have mental health insurance, you can pay for services yourself. Fees vary, but many providers are willing to charge fees based on your income (sliding scale).

Medicaid is a program that helps pay for the cost of healthcare for people with low incomes and limited assets. It is paid by federal and state governments. Generally, people who qualify for Medicaid are women, children, and older or disabled adults. Medicaid rules change. Also, the Medicaid program varies somewhat from state to state. For more information, check with your local social services department.