According to NAMI, the National Alliance on Mental Illness, an estimated one out of five U.S. adults experience a mental health issue every year. However, many of those afflicted do not seek help for their problems due to a litany of reasons, such as the stigma associated with mental health or cost.
Understanding health insurance can be confusing to the average person when dealing with even a typical cold or flu alone, so understanding mental health coverages can be much more difficult. When assisting your clients to see if their policy will cover any kind of therapy, you should first check their insurance policy’s “Mental Health” or “Behavioral Health” section for allowed coverages as well as copay requirements.
Most employer-sponsored health insurance plans do offer some form of mental health coverage. Now, if your client is currently uninsured and seeking a policy that will assist with mental health issues, have no fear, under the Affordable Care Act (ACA), policies are required to have some sort of mental health as well as substance abuse coverage, as part of the ten essential pillars the ACA requires. This includes most policies today, except those older than the ACA, which are grandfathered in regardless of their coverages.
However, non-Marketplace plans, while required to have some form of Mental Health coverage, may not necessarily be required to offer therapy specifically.
Additionally, the ACA eliminated pre-existing condition clauses in ACA-approved health insurance plans, meaning that your client cannot be denied coverage if their mental health condition was pre-existing before they bought their insurance plan. Additionally, insurers cannot place an annual or lifetime limit on their amount spent on mental health services.
When selecting a psychologist or therapist, it is essential to remember that not all therapists accept every plan. The easiest way for your clients to find a provider that will take their selected insurance plan is to search for a provider on the insurance company’s website.
Suppose your client has a pre-existing mental health provider they wish to utilize. In that case, many practitioners are willing to file for payment regardless of their insurance company. Still, they may require full payment upfront and reimburse your client once their insurance has paid.
Some therapists offer sliding scale cash pay prices dependent upon the patient’s income, so your client’s desired therapist’s cash pay price may be less than their potential insurance copay for therapy. Tell your clients to check with their provider to see if they offer this type of pricing.
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