Mental health is integral to your overall wellbeing. But since insurance coverage can be confusing, you may wonder if your insurance plan covers the care you need to maintain your mental health. Read on to learn about insurance coverage for therapy and other mental health services and what to do if you insurance has denied a mental health claim.
Does Health Insurance Cover Mental Health?
A federal law that was passed in 2008 (the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act) requires insurance plans to cover mental health services in the same way they cover physical health services. This means that insurance companies must provide the same level of financial coverage for mental healthcare as physical healthcare. As an example, your copay for a mental healthcare visit cannot cost you more than a copay for any other kind of specialist visit.
This law affects both individual health plans and health coverage through an employer with at least 50 employees.
What’s important to understand about the parity law, however, is that it doesn’t compel insurance companies to pay for mental health services, just to cover any included mental health services the same way physical services are covered. Luckily, most plans already offer some form of mental health coverage.
Does Insurance Cover Therapy?
Talk therapy is an essential component of mental healthcare. Seeking therapy involves visiting a psychologist, psychiatrist, social worker, or licensed professional clinical counselor in order to discuss your issues or receive a mental health diagnosis. But if you’re considering attending therapy sessions, you’ll want to check whether or not it’s covered by your insurance plan first.
Many people pay out-of-pocket for therapy services, as mental health insurance coverage will typically only pay for medically necessary therapy. That means that the therapist needs to diagnose you with a medical issue (such as insomnia, anxiety, phobia, or PTSD) to bill your insurance for sessions. If they are unable to diagnose you yet still submit a claim to your insurance for payment, you may receive an insurance claim denial.
How to Check Which Mental Health Services Your Insurance Covers
There are a few ways you can look at your health insurance plan’s mental health coverage:
- Check Your Online Account. Most insurance companies provide their subscribers with an online platform where you can find plan information, pay your premiums, and search for in-network providers.
- Look Over Your Plan Documents. When you first sign up for an insurance plan, you should receive either an electronic or hard copy of your plan documents. These documents outline all the services that are covered in your insurance plan.
- Call Your Insurance Provider. When it doubt, give your insurance provider’s customer service line a call and ask a representative to check on your mental health coverage.
- Ask HR. If you receive health insurance through your employer, check with your company’s human resources department for covered services. They should have access to this information.
How Much Does Therapy Cost Without Insurance?
A typical one-hour session with a therapist costs anywhere from between $65 and $200 out of pocket. This number varies based on the therapists experience and education (you’ll pay more for a licensed psychotherapist than for a counselor), as well as other factors like location.
What Mental Health Services Does Insurance Cover?
If your health insurance plan does cover mental healthcare, chances are it will include the following services:
- Emergency Psychiatric Treatment. If you have to be hospitalized for a psychiatric emergency, your health insurance plan should cover any treatment you receive.
- Talk Therapy. Most insurance plans do cover talk therapy, although you may be limited to a certain number of sessions per year or have to prove medical necessity.
- Outpatient Care. This broad term covers all treatment that you receive in an outpatient facility. This may include psychotherapy, behavioral therapy, stress management, testing, or even visits to discuss psychiatric medication.
- Telemedicine. If outpatient mental healthcare is covered, chances are that those same services are available to you through telemedicine.
- Online Therapy. Depending on the area you live in, there may be few options for in-person therapy covered under your plan. That’s why many plans cover online therapy with trusted providers.
- Inpatient Treatment. Your health insurance may cover inpatient treatment for certain mental health issues. Inpatient treatment is recommended when your mental health issues threaten your life or ability to get through a normal day on your own. Inpatient treatment allows you to receive personalized care in a hospital environment.
- Addiction Treatment. Sometimes substance abuse treatment falls under the umbrella of mental healthcare. Insurance plans are required to cover substance abuse, which is classified as a pre-existing condition. This may include rehab coverage, medication, or therapy services.
Why Do Mental Health Claims Get Denied?
Unfortunately, even after the great strides the US has taken toward adequately covering mental healthcare, it’s still possible to get a denied mental health claim. Here are a few reasons your mental health claim may get denied:
- Not Medically Necessary. Let’s say you’re seeking talk therapy to build your confidence, or simply want to chat about life with a psychiatrist, even without the presence of any diagnosed mental health conditions or physical symptoms. If the therapist you’re seeing can’t prove that your sessions are necessary to your health, you may receive a denied claim from your insurance.
- Didn’t Obtain Prior Authorization. Depending on your plan, some mental health services may require prior authorization from your insurance. If you go ahead and get a procedure, test, or treatment done without obtaining the required prior authorization, there may be an insurance denial in your future!
- Incorrect Paperwork. Mental healthcare providers, like any medical professionals, do their best to provide care and then submit carefully checked paperwork to your insurance. Sometimes, however, they make a mistake in the paperwork (such as misspelling your name or skipping a digit in your member ID number), and the claim is then denied by insurance.
- Didn’t See an In-Network Provider. Before seeking mental healthcare services, check to make sure the provider you’ve made an appointment with is in your insurance network. If not, you’ll receive an insurance denial for visiting an out-of-network doctor.
Does Medicare Cover Mental Health Care?
Generally Medicare does cover mental healthcare, although this depends on your specific plan. Under Medicare Part A, behavioral health and substance abuse services should be covered. If you are hospitalized for mental health problems, you may have to pay a deductible along with coinsurance.
Therapy, depression screening, and other outpatient mental healthcare services are covered under Medicare Part B. You still may be responsible for a copay, deductible, or coinsurance for these services as well. Medicare Part C offers therapy coverage equal to or more comprehensive than original Medicare does.
Typically Medicare’s mental health coverage also includes family therapy, testing, psychiatric evaluation, and medication management services.
Does Medicaid Cover Therapy?
Yes, Medicaid does cover therapy under its mental health coverage. In fact, Medicaid single handedly pays the most for mental health services in the US! With Medicaid, you have access to in-person and online therapy services, including group and family therapy. As long as you have a diagnosis to prove medical necessity, your therapy should be covered.
Even with Medicaid’s broad mental health coverage, services like couple’s counseling, career coaching, massage therapy, acupuncture, and other holistic treatments are generally not covered.
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What Happens When a Mental Health Claim is Denied?
When a mental health claim is denied, you’ll receive a letter informing you of the denial. Then, you’ll get a bill from the provider for the amount that your insurance didn’t cover. Depending on the service, that bill can be anywhere from a few dollars to thousands!
Now, not only will you have to figure out how to afford the bill for mental health services, but you’ll also realize that you won’t be able to receive the same service in the future and count on coverage. If you feel unable to maintain your mental health without the denied treatment, this may produce a whole lot of worry and stress—not what you need when dealing with a mental health issue!
How to Negotiate a Mental Health Medical Bill
Luckily, even after you receive a denied mental health claim, not all hope is lost. There are a few ways you can proceed in order to fight for the coverage you need. The first, and easiest, is to go through your insurance provider’s appeal process. This means calling your insurance company to ask that they give the claim another look, then waiting weeks or months for a decision.
If your first appeal is unsuccessful, you may be able to request an independent review process directly from your insurance provider. Other times, you may reach a dead end after one appeal and need to reach out for external help.
This external help can come in the form of a medical bill attorney, professional medical billing advocate, or a second opinion from your state government’s review team. In any case, one of these medical billing experts can help you figure out whether or not you’re entitled to insurance coverage for a denied claim. If that doesn’t work, a medical billing expert can still speak to the facility where you received care in order to get your bill lowered.
How aJust Can Help With Mental Health Medical Bills
With aJust in your corner, you’re guaranteed a high chance of a successful mental health bill negotiation. That’s because aJust has seen it all, and they’re prepared (with years of experience and industry expertise) to fight for coverage or a discount on your behalf.
Unlike medical bill attorneys, who come with high fees and the stress of a court case that can span months, aJust will take over your case without any extra time or effort on your part. If aJust is unsuccessful at lowering your medical bill, you owe nothing. Plus, they can solve your medical billing issues far quicker than a state review board.