Every year, less than half of the 16 million American adults with depression receive treatment. Overall, only one in five of the 44 million people with mental health conditions get professional care, according to Mental Health America. For many, it starts with a simple question: does health insurance cover therapy?
Before they even seek an answer, the stigma surrounding mental illness shuts them down. It’s disheartening to know that so many go without treatment, given that today, insurance coverage for mental health services is available. All thanks to provisions of the Mental Health Parity and Addiction Equity Act and the Affordable Care Act.
Does All Health Insurance Cover Therapy?
While all health insurance policies will cover therapy and mental health services in a perfect world, that isn’t the case. Federal laws require health plans that offer some mental health benefits to offer comparable benefits to medical coverage.
Still, the federal law only applies to:
- Employer-sponsored health plans for companies with 50 or more employees
- Individual health plans purchased through the health insurance exchange or health insurance marketplace plans
- Children’s Health Insurance Program (CHIP)
In addition, state-run Medicaid plans must cover essential health benefits, including mental health and substance use services. However, these plans vary by state. Also, Medicare plans may cover some mental health services, although it depends on the type of plan.
For example, Medicare Part A covers some inpatient behavioral health and substance use services. Medicare Part B covers most outpatient mental health services, including annual screenings. Then, Medicare Advantage Part C covers some therapeutic services at the same level as the original Medicare.
How to Find Out If My Health Plan Cover Therapy?
Of course, the easiest and fastest way to understand your coverage is to contact your insurance provider. Or, you can contact a facility directly and have them verify your insurance coverage for a specific treatment.
Another way to find out is to visit your insurance provider’s website and look at your health benefits. Here, you should be able to see a table that outlines your coverages. Look for the category that talks about “mental health, behavioral health, or substance abuse services.”
You’ll be able to see if you have a copay or coinsurance for these services. It will also outline different costs for in-network providers and out-of-network providers.
If you need help understanding your plan, call your insurance company and ask about your mental health coverage.
Is Therapy Medically Necessary?
For insurance coverage, not all therapy is deemed medically necessary. The same goes for mental health services in general. For example, dealing with stress at work or struggling to cope after moving to a new city might not warrant health-insurance-covered therapy. However, if an assessment rules out a mental health disorder, the parity law says therapy should be covered.
Still, this doesn’t mean you need a formal diagnosis before you can seek therapy.
For insurance purposes, therapists can use a diagnostic code for depression, panic disorder, or anxiety. This provisional diagnosis can help get you into your first visit with insurance coverage. But, these diagnostic codes can change in future visits.
Mental Health Services Typically Covered by Insurance
Although treatment coverage varies tremendously, one thing remains consistent: for health insurance to cover therapy, it must be medically necessary. So, you can get mental health services like:
- Psychiatric emergency visits
- Dual-diagnosis treatment
- Cognitive-behavioral therapy
- Outpatient sessions with psychiatrists, clinical social workers, and clinical psychologists
- Online therapy
- Inpatient behavioral health services
- Addiction treatment
- Medical detox
- Medication-assisted treatment
The extent of coverage for specific mental health treatment, such as the length of rehab or number of outpatient visits, varies from plan to plan. So does the coverage and out-of-pocket cost for any medications you might need to treat your condition, both as an inpatient and outpatient.
The truth is that since insurers offer an array of plans, it’s impossible to give the specifics of each plan they cover. The best way to understand your health coverage is to talk to your insurance provider. After the Affordable Care Act, insurer coverage for mental health services includes Aetna, Blue Cross Blue Shield, Cigna, and more. These are among the largest insurance companies in the nation.
If you or someone you know is struggling with their mental health, please seek help. At Lighthouse Recovery, our admission specialists can help you understand your health insurance plan better and verify your insurance. Get started in your journey to seek mental health care today.