What you need to know about mental health insurance coverage
Mental health is just as important as physical health when it comes to your overall well-being. But not all insurance plans cover mental health the same way. We’ve got answers to your top questions about mental health insurance coverage.
Mental health care has changed for the better in recent years. More health plans offer mental health benefits than ever before. And as access to mental health care improves and out-of-pocket costs drop, treatment rates go up and symptoms start to improve. This is great news when you learn that almost 1 in 5 American adults are dealing with a mental illness like depression or anxiety.
Even so, not all mental health coverage is created equal. There’s a lot of variety between plans. That can include:
- Which therapies are covered.
- Who you can see.
- How much you pay out of pocket.
“Just as there’s no one-size-fits-all approach to mental health in general, all the different health plans and services evolve and change,” says Susan Beaton, RN. Beaton is vice president of Health Plan Strategy at Wellframe, a digital health management company.
So what can you do to get the best possible mental health resources from your health plan? Read this simple guide for answers to top questions.
Do all health plans have to offer mental health benefits?
Since 2014, federal law has required that most individual and small employer health plans cover mental health and substance use disorder services. That includes all plans offered through the Health Insurance Marketplace.
Mental health benefits generally can’t be more restrictive than coverage for medical and surgical services. That’s thanks to a federal law known as the Mental Health Parity and Addiction Equity Act (MHPAEA). For instance, say a health plan charges a $20 copay for most medical and surgical office visits. That means it can’t charge a $40 copay for office visits to a mental health therapist.
What mental health services are covered by insurance?
Quite a few, says Beaton. On the list:
- Psychiatric emergency services.
- Treatment for behavioral and health conditions that occur together. For example: addiction and depression.
- Talk therapy, such as psychotherapy or cognitive behavior therapy.
- In-patient behavioral health services. These may be at a hospital or rehabilitative facility.
Keep in mind these services usually aren’t unlimited. True, the parity law stops insurers from putting a set limit on mental health coverage. But insurers can look at your case to decide if treatment is medically necessary.
“Insurance companies have to approve things like physical therapy or cardiac rehab. They do that with mental health services as well,” says Beaton. “The rules now apply equally across the board.”
Does coverage include teletherapy?
During the COVID-19 pandemic, all health plans let mental health professionals offer teletherapy through online secure platforms, says Molly Zive, LCSW. Zive is a psychotherapist based in San Diego. Teletherapy includes either video calls with an in-network professional or through a third-party service. Right now there are no cutoff dates for teletherapy mental health coverage due to COVID-19, but this could change. Talk to your plan about your options, Zive says.
For now, it looks like teletherapy may be here to stay for most health plans, says Beaton. “It gained popularity because there was so much need. There simply weren’t always enough therapists to see people in person,” Beaton says. Case in point: Text messages to the federal government’s disaster distress hotline jumped by more than 1,000% in April 2020 compared to a year earlier.
“There’s a recognition now that when someone is in a mental health crisis, one of the best ways to reach them is through their cell phone,” says Beaton.
Can my plan limit how many therapy sessions they will cover?
Yes. No matter your diagnosis or progress, health plans can limit the number of sessions you have. “This is why many therapists, including myself, stopped taking insurance,” says Zive.
For this reason, it’s important to talk to someone from your health plan. Ask how many sessions will be covered. “You don’t want to be surprised with a huge bill if you have to pay out of pocket due to coverage being limited,” says Zive.
Will my copay be the same as when I see my primary care physician (PCP)?
No. A mental health therapist is considered a specialist. Let’s say you pay $20 to see your PCP but $40 to see your dermatologist, for example. You can expect to pay the higher amount for a therapist as well. “Contact your insurance provider. Find out what your copay is. And communicate it to your therapist,” says Zive.
Do all therapists accept my health insurance?
No. Mental health providers can decide which health plans they want to accept. They can also choose not to accept any at all. “Therapists who don’t accept any insurance are considered out of network,” says Zive.
To see if you have coverage for out-of-network benefits, Zive suggests that you call your health plan. If you do, and you are seeing an out-of-network provider? You’ll need to complete an insurance claim form. Then submit the form along with the provider’s invoice to get reimbursed.
You might also decide to stick with only in-network providers who take your insurance. Your health plan can give you a list of in-network therapists. You can ask for the list through a digital health management app like Wellframe. Or go to the therapist’s website to see if they accept your insurance. While you’re there, make sure they are taking new clients.
Many health plans offer the Wellframe digital health management app as a benefit to their members at no extra cost. Don’t know if yours does? Reach out to your health plan representative.
How do I find out what my plan covers?
“Not to sound like a broken record, but the best way is to call the number on the back of your insurance card labeled behavioral health or mental health services to find out your coverage,” says Zive.
You can also often make it easier by using the Wellframe app, adds Beaton. “It can be hard to decipher what your plan covers with all the legal language,” Beaton says. “This way, you can chat in privacy with a nurse or Wellframe team member to get the answers you need.”
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