How Health Insurance Handles Mental Health Coverage

In the past, mental health services were often excluded from health insurance plans, or they were subject to higher deductibles and copays. However, with the passage of the Mental Health Parity and Addiction Equity Act of 2008, health insurance companies were required to treat mental health and substance use disorders equally to medical and surgical benefits.

Today, most health insurance plans provide some level of mental health coverage. These benefits typically include:

• Outpatient mental health services, such as counseling or therapy sessions
• Inpatient mental health services, such as hospital stays for severe mental illness
• Partial hospitalization programs, which provide intensive therapy during the day, but allow patients to return home at night
• Residential treatment programs, which provide 24-hour care for severe mental illness or addiction

But how do health insurance companies determine what mental health services to cover? Insurance companies use a variety of factors to determine coverage, including:

• The type of mental health condition being treated
• The level of care required (e.g., outpatient vs. inpatient)
• The qualifications and credentials of the mental health professional providing treatment
• The effectiveness of the treatment

In some cases, health insurance companies may require pre-authorization or pre-certification before covering mental health services. This means that the patient or mental health professional must obtain approval from the insurance company before treatment begins.

Despite these advances in mental health coverage, there are still some limitations. For example:

• Some insurance plans may have higher copays or deductibles for mental health services
• Some plans may limit the number of therapy sessions or treatment days covered per year
• Some plans may not cover certain mental health conditions, such as mental health diagnoses that are related to a pre-existing medical condition

Navigating these complexities can be challenging, but there are steps you can take to ensure you receive the mental health coverage you need. Here are some tips:

• Review your insurance plan carefully to understand what is covered and what is not
• Ask your insurance company about any pre-authorization or pre-certification requirements
• Choose a mental health professional who is part of your insurance company’s network
• Keep track of your mental health appointments and bills to ensure you receive accurate reimbursement