Traditionally, mental health was not mentioned anywhere under health care summaries. Mental health has been overlooked in many areas of society up until now. It took 2020 for people to really start owning up to their mental illnesses and advocating more for the people who are unable to speak, even when wanting to.
Mental health coverage is something people assume can help manage illnesses such as anxiety disorders, depression, trauma, bipolar disorder, and other mental health issues.
Yet this mental health coverage is available for everyone to get evaluated and seek treatment during any sort of traumatic event or lifetime hardship.
Depending on what is right for you (what the Psych prescribes) This is what you could be looking at:
- Psychiatrist: First stop! Seek out a person that can give you a full diagnosis and prescribe medications that coincide with your therapy and counseling. This person is going to be your main doctor, yet you only talk so much with this doctor about your personal problems and traumas. The talk therapist is next to do that for us.
- Psychologist: You will have sessions with this therapist about as often as the Psychiatrist recommends. The talk therapist (Psychologist) will recommend their own treatment plan for you. These sessions will help you connect with your emotions and behavioral issues. Individual sessions are recommended at first, yet you can find a psychological that does family, couples, and other groups.
Psychologytoday.com has great resources for choosing the right psychologist (also known as a counselor and disguised as that sometimes for privacy. Then people think of this person more as your Mentor and they are in a way!) The Psychiatrist and Psychologist, with your permission, can work together to prescribe medications and provide therapy based on what you are talking about in your personal sessions.
- Medication: The first doctor, the Psychiatrist, is the one licensed to prescribe the medication. There are some nurses with a degree allowing them to prescribe medication too. I am an Insurance Expert therefore knowing all those degrees is beyond me, yet there are other people whom you can see outside of just Psychiatrists.
Try to get your medications in generic form when possible as it will be the best cost savings to you. All plans have a formulary with different tiers. The higher the tier the more expensive the prescription will be. You can get these prescriptions authorized when being in a position where that is the only medication that works for you or that you can try. The doctor will work with you and your insurance to get a prior authorization when needed.
- Inpatient or outpatient care: Inpatient care is full-time care in a hospital or a specialized mental health facility. You might need it for severe conditions that require more care. With outpatient care, you go home when you’re not having treatment. Outpatient care may include regular therapy sessions, psychiatric evaluations and appointments to make sure your medication is working correctly.
- Telehealth services, where you can have counseling or medication management through online appointments. These are commonly done virtually after making a few in-person appointments. There are laws in place where you do have to see a doctor to receive a diagnosis and other proper forms of practice and treatment.
- Consider Group Therapy: NAMI.org has great resources on local groups in your area. The peer-to-peer support groups and even family groups will help greatly during this time. It is good to consider finding support in the local community with people who are going through the same experiences that you are having.
- Consider Advocating: NAMI.org also has was where you can donate your time in the community as a volunteer. There are many ways you can advocate for mental health in your local city or county. Speakers go out and talk about it at schools, churches, and other events. Consider being an advocate for mental health once being treated and healed yourself.
This guide from InsuranceTricks.Tips (Insurance Courses provided for educational purposes) can help teach you more about what health insurance you will need through the courses we offer. See that tab above.
What to know about reviewing your mental health coverage
By law, insurance plans must provide equal coverage for mental health along with other health services.
For example: If you have a $25 copay when you see your primary care doctor, you can’t have a copay higher than $25 to see a mental health provider. This stops a provider from charging more for mental health simply because it is mental health. We deserve a level playing field and no discrimination.
You may be responsible for deductibles, copayments and coinsurance. It’s important to review your policy and talk to your insurance provider so you understand the details of your coverage.
You can usually find this important information on your health insurance provider’s website or member portal:
- Your full policy and evidence of insurance.
- ID cards
- Summary of benefits and coverage, which outlines your plan’s key features and expenses.
- Explanation of benefits, which explains what claims were processed and what you may owe.
- Provider network directory, which lists the in-network mental health care providers for your plan. In-network providers have contracts with your insurance company, so your costs are lower.
- Customer service hotline number, in case you have any questions.
Important Information People Need to Know and Understand about Mental Health Services:
- Visit state and local city/ county resources before even using your insurance (or if you happen to be an individual that is going through this with no insurance). Each state is required by federal law to provide resources such as nurses that can write prescriptions, medications, hospitals, and other services for no cost to the patient.
- These resources are available TO ANYONE! You have to say that you don’t have insurance and show them your income information. Usually just paycheck stubs depending on your job of course. Each state has different resources available, yet I am in Nevada where there is basically nothing and we have Northern Nevada Adult Mental Health Services (NNAMHS) here. They do provide help to the community.
- From all medical providers, you can make $100,000 a year, and they still must see you when you don’t have insurance. When you do gain insurance, your payments would be based on your insurances rate, and they usually want people to go out and see private doctors at that point. They need resources for newer people.
Here are some ways to lower your costs.
- Use in-network providers.
- Choose generic medications, if possible.
- Consider having telehealth appointments instead of in-person sessions. Depending on your provider and insurance plan, they can sometimes be more cost effective, especially when considering travel and time off for in-person sessions.
- Ask your therapist if they have sliding-scale fees. If they do, your fees may be less if you have lower income.
- Appeal any claims that are denied. Sometimes, they are denied by mistake or sometimes appeals are approved. They will sometimes adjust the bill to reflect a discount.
- Going over 20 sessions of therapy per calendar year. You might be able to get this extended with the help of your therapist, yet there are session limits.
- Keep track of your health care expenses. They may help you save money on your taxes. You can also check them to see if you should change your insurance plan for next year. FSA might be available to you for this and could be taken advantage of at your place of employment.
In the End
Mental health care is important for your overall health, and this is for everybody, not just people who have a diagnosis already. Insurance companies must cover mental health expenses equally as other health expenses. When reviewing your policy, understand that you will have the same coverage for your mental health issues as you will for your other medical conditions.
Call 988 at any time for help and resources involving mental health. This is also known as the suicide hotline and has been around for a few years now to help us with mental crisis. There are other warm text hotlines and NAMI.org is another popular resource.
