Mental Health Insurance Coverage: Know What's Covered And What's Not

When we purchase health insurance as a safety net for if we become ill or injured, we're usually thinking of physical ailments. But mental illness can be just as urgent and costly, so it's important to know just what your health insurance does - and does not - cover in terms of mental health treatment.

Thanks to recently enacted federal rules, insurance companies are required to maintain a level of parity between the coverage they provide for mental and physical illnesses. What this means is that, if the insurer elects to offer mental health coverage (they are not required to offer it), co-payments and deductibles for mental health treatment cannot be higher than or separate from those set for treating physical conditions. However, these rules apply only to group insurance plans, such as you might receive through an employer - plans sold directly to individuals or families are not included in the federal rules, although they may be regulated at the state level.

Questions to ask about your mental health insurance coverage:

  • Do I need a referral from my primary care doctor in order to receive specialized mental health treatment? Many insurance plans require a referral before approving treatment by a specialist.
  • Do I have to choose from a certain list of providers, or can I see any mental health specialist I choose? If you're enrolling in a new insurance plan and are currently seeing a provider you like, you'll want to make sure you don't have to switch to qualify for coverage. It's also a good idea to make sure there are several reasonable choices of providers, so you have more than one option in case you do wish to find a different provider for any reason.
  • What diagnoses and pre-existing conditions do the plan cover? Not all mental health insurance covers all disorders - substance abuse disorders, for example, may be excluded from coverage - and insurance companies currently may place restrictions on pre-existing conditions, although this is scheduled to change in the future.
  • What types of services are paid for by the insurance plan? Plans may or may not cover all types of office visits, medications, or inpatient care, for example. There may be limits placed on the number of visits, or on the types of medication that will be covered.

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