Mental Health Benefits: How to Get the Most Out of Your Healthcare Coverage
When it comes to wellbeing, mental health is just as important as physical health. But, health insurers haven't always seen it that way. In the past, many health insurance companies provided better coverage for physical illness than they did for mental health disorders. That has since changed, partially due to new legislation.
A law passed in 2008, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act (also known as the mental health parity law or federal parity law), requires coverage of services for mental health, behavioral health and substance-use disorders to be comparable to physical health coverage. Yet, many people still aren't aware that the law exists or how it affects their mental health benefits.
"Insurance companies can make accessing mental health benefits feel daunting," said Jill Daino, a Talkspace therapist based in New York, New York. "One important thing for people to understand and that many may not know is that mental health coverage is provided at parity with medical coverage for most policies.
This is important to understand because if your coverage doesn't limit medical care for diabetes, for example, it also cannot limit mental health care coverage for depression. The challenge is if someone has a policy that has limited coverage overall, the mental health coverage will also be limited."
About one-half of all covered Americans are enrolled in large self-insured health insurance plans that are subject to federal parity. The federal parity law doesn't require plans to offer coverage for mental health or substance use, but if they are covered, then the law requires that coverage is equal with coverage for other health conditions.
"Understanding your particular mental health benefits is key to making the most of them and using the coverage," Daino said. "There are a few ways to find out exactly how your plan works.
Depending on where someone works you may have access to a human resources or benefits manager to help explain the coverage and how it works. In addition, every insurance company has a toll free number or website where you can contact them and ask questions about your coverage."
5 Questions You Should Ask About Your Mental Health Benefits
Nobody will ever accuse the health insurance industry of being too simple, and individual plans vary wildly in the amount and type of mental health benefits offered. If you are unsure about what type of plan you have, ask your insurance carrier or agent, your plan administrator or your human resources department the following 5 questions for a better idea of your benefits:
Do I have to get a referral from my primary care physician, pediatrician, or employee assistance program to access my insurance's mental health benefits?
2) Provider Network
Is there a preferred list of behavioral health providers or network that I must see? Are child psychiatrists or addiction specialists included?
What mental health benefits are paid for by the plan: online therapy or brick-and-mortar, office visits, medication visits, respite care, intensive outpatient programs, day hospital, inpatient?
Is there an annual deductible that I pay before the plan pays? What will I actually pay for the mental health benefits I use?
Are there limits on the number of visits per year? Will my provider have to send reports to the managed care company?
Where to Start
Your employer may offer some mental health benefits within an Employee Assistance Program. EAP benefits are paid for by your employer, accessing benefits are usually free, and the problem you seek help for doesn't have to be work-related.
While EAPs aren't designed to provide long-term treatment, a mental health professional will evaluate your needs, initiate crisis intervention or short-term treatment, and provide referrals if the EAP services aren't sufficient to resolve the issue.
Check your employee benefits handbook or call your benefits office to see if you have an EAP. Remember: your health claims, including mental health claims, are confidential and will never be shared with your employer.
If you don't have an EAP, or want to take another route, start with your doctor.
"Given that at times a referral is necessary from a primary care physician in order to obtain coverage, it is crucial to be able to advocate for yourself with your primary care physician," Daino said.
"It is important to have a conversation about your symptoms, concerns, and why seeing a mental health professional is important to your overall health in order to get an appropriate referral for that coverage to be approved.
If you do not have a relationship with a primary care physician it can be more challenging as you will need someone to get to know you and understand your needs to provide the referral. Ongoing medical care is a vital component to mental health care so establishing a relationship with a primary care physician is crucial."
Persistence Pays Off
Navigating your health insurance, and especially your mental health benefits, is never easy. But it's important to take good care of yourself. The answers are out there - don't be afraid to ask questions in order to get the care and benefits you deserve.
About the Author
Dr. Leibowitz is a psychiatrist and the Chief Medical Officer of Talkspace. He is an expert in bioethics, with a background in law and private practice. Talkspace is the industry leader in online therapy that makes mental healthcare more convenient and accessible by connecting users with licensed therapists through a HIPAA-compliant and easy-to-use proprietary app.
With Talkspace, users can send multimedia messages to their therapists via web browser or the Talkspace mobile app anytime, anywhere. Therapists engage daily, 5 days a week.