Mental health is a significant (and often-overlooked) aspect of overall well-being. Yet, many of us may struggle to access the treatment we need due to financial constraints, geography, or lack of understanding coverage for mental healthcare, therapy, or counseling by our insurance plans.
So let's tackle that third aspect –
Is treatment for mental healthcare, therapy, and counseling covered by insurance?
How does mental health insurance coverage works?
What is insurance for mental health?
Fortunately, most insurance plans cover treatment for mental health conditions, but it's essential to understand what's covered and not.
As someone who has struggled with mental health issues, I understand the importance of accessible treatment. I also know how confusing and overwhelming it can be to navigate the insurance system and understand coverage. Copays, deductibles, out-of-pocket fees, in-network, out-of-network? The jargon is nearly endless – so it isn't difficult to see why understanding the ins and out's of insurance coverage can be daunting.
I may not dive into definitions here, but I want to provide an overview of what types of insurance cover mental health treatment and what to expect when seeking counseling or therapy for your mental health needs or goals.
First and foremost, it's important to understand the types of insurance that may cover mental health treatment. Some of the most common ones include:
• Private health insurance: Many private health insurance plans include coverage for mental health treatment. This can include individual and family plans, as well as group plans offered through an employer. Some plans may require a primary care physician referral before they cover mental health treatment.
• Medicaid and Medicare: Both Medicaid and Medicare offer coverage for mental health treatment for eligible individuals. This can include inpatient and outpatient care, as well as prescription medications.
• Military and Veterans Affairs (VA) benefits: Active-duty service members and veterans may be eligible for mental health coverage through the Department of Defense or the VA.
It's important to note that not all insurance plans will cover all types of mental health treatment. Some plans may only cover certain types of treatment, such as inpatient care or prescription medications. Others may limit the number of visits or the amount of coverage available.
It's becoming increasingly difficult to find a plan that doesn't provide mental healthcare coverage – and it's getting better every day!
To find out what's covered under your insurance plan, you’ll need to review your plan's summary of benefits. And often, the best way to get a complete understanding is to contact your insurance provider directly. They'll be able to fill you in on the specific types of mental health treatment covered, as well as any limits or exclusions that apply to your particular plan.
It's also worth noting that some insurance plans may require you to see a provider within their network to receive coverage. If you are seeing a therapist or counselor who is not in your insurance plan's network, you may have to pay more out of pocket for your treatment. Or, the provider may provide you a superbill to submit to your insurance for reimbursement.
What is a superbill exactly?
A superbill is a document provided by a healthcare provider, such as a therapist or psychologist, that contains detailed information about the services that were provided during a visit. It is usually used for patients who are seeking reimbursement from their insurance company for out-of-network or out-of-pocket expenses.
A superbill typically includes information such as the date of service, the type of service provided, the diagnosis, and the billing codes. It also includes the provider's name, address, and Tax ID number.
The superbill is not an invoice, it is a document that the healthcare provider generates and provides to the patient so they can submit it to their insurance company for reimbursement. The patient will then be responsible for submitting the superbill to their insurance company along with any other required documentation, such as a claim form.
It's important to note that not all insurance companies accept superbills and some may require additional information or forms to be submitted with the superbill. It's important to check with your insurance company to understand their specific requirements and procedures for submitting a superbill for reimbursement.
It's also important to note that some states laws or regulations may apply to superbills, like requiring specific information or format.
Basically, a superbill may allow a person to get reimbursement from their insurance company if they are seeing an out of network counselor or therapist. you’ll be responsible for submitting the superbill to your insurance company along with any other required documentation. It's important to check with your insurance company to understand their specific requirements and procedures for submitting a superbill for reimbursement, as they may not always reimburse!
Outside of superbills, another aspect to consider about general mental health insurance coverage is that some insurance plans may require pre-authorization before treatment can begin (although this is becoming rarer and rarer). Some may require you to try a less expensive treatment before they approve a more expensive one (again, not very common when it comes to mental healthcare – but worth noting!).
What happens if insurance plan doesn't cover the treatment you need?
There are a few options to consider:
• Out-of-pocket: If your insurance plan doesn't cover the treatment you need, you may have to pay out of pocket. This can be expensive, but some providers may offer sliding scale fees based on income or offer financing options.
• Community resources: Many communities have free or low-cost mental health clinics or support groups. These resources can provide valuable support and treatment, even if you don't have insurance.
• Employee assistance programs (EAPs): Some employers offer EAPs, which provide employees with free or low-cost mental health services. Though, be aware – it is a bit more difficult to find therapists, especially in outpatient settings that accept EAP benefits.
What about Outpatient Mental Health Therapy coverage, specifically?
Several factors are worth considering when considering insurance coverage for mental health therapy in an outpatient setting. Let's run through 8 of them worth being aware of:
1. Network Providers: Many insurance plans have a network of providers they have contracted to provide services at a discounted rate. It's essential to check if the therapist or clinic you are considering is in-network with your insurance plan, as out-of-network providers may not be covered or may require a higher out-of-pocket cost.
2. Copayments and deductibles: Some insurance plans require copayments for each therapy session, and others require individuals to meet a specific deductible before coverage kicks in. Understanding these costs and how they will impact your overall expenses is important.
3. Frequency and duration of therapy: Insurance plans may limit the number of therapy sessions they will cover in a given year or limit the duration of therapy. Understanding these limits and how they may impact your treatment plan is important.
4. Out-of-network coverage: If you choose to see a therapist, not in your insurance network, you may still be covered, but at a lower rate. It's important to check with your insurance provider to understand out-of-network coverage and how it will affect your costs.
5. Pre-authorization: Some insurance plans require pre-authorization before treatment can begin. You will need to get approval from your insurance provider before starting therapy. It's important to check with your insurance provider to understand the process and any requirements for pre-authorization.
6. Behavioral Health Integration: Many insurance plans now offer Behavioral Health Integration (BHI), where primary care doctors and mental health providers work together to coordinate care for the patient. This can be an excellent option for those with physical and psychological health concerns.
7. Type of therapy: Different types of treatment, such as talk therapy, art therapy, and music therapy, may be covered differently by insurance plans. It's a good idea to check with your insurance provider to understand what types of therapy are covered and how they will be paid for.
8. Medication coverage: Some insurance plans may also cover medication prescribed by a mental health provider. It's important to check with your insurance provider to understand what prescriptions are covered and how they will be paid for.
It's important to note that insurance coverage for mental health counseling can be complex and may change over time. It's important to periodically check with your insurance provider to understand any changes in coverage or to have a clear understanding of your coverage.
It's also worth mentioning that some states have laws that mandate a certain level of coverage for mental health by insurance companies, so check your state's laws and regulations to ensure you are getting the coverage you are entitled to.
That list may be a bit overwhelming at first – but here's a quick summary to pull it together:
- If you're unsure about your coverage specifics, contact your insurance company directly. (their members' information contact number is usually listed on your insurance card!)
- If you're unsure about certain costs for a specific provider, therapist, or counselor you want to see – call them! Usually, they can help explain the process of verifying your information and ensure your experience is seamless as you begin your therapy journey.
Just remember, mental healthcare is huge when it comes to your overall well-being, and many insurance plans cover treatment for mental health for various needs, goals, or conditions. And don't forget, if your insurance plan doesn't cover the treatment you need, other options exist, such as out-of-pocket payments, community resources, or employee assistance programs. It's also important to remember that seeking help for mental health issues is never a sign of weakness, and options are always available to help you get the treatment you need!
If you've read this far and are seeking outpatient mental healthcare, reach out to us today! We're excited to help you accomplish your therapy goals!