One reason many people delay getting the help they need for an addiction or dual diagnosis is they don’t think they can afford treatment. Camelback Recovery works with major insurance companies to ensure you get access to the programs you need to help you become sober, prevent relapses, and get the support you need if you do fall back into your habit.
Does insurance cover mental health treatment, read on to find out the answer. This guide reviews what you need to know about mental health benefits and how you can obtain mental health treatment through your health insurance.
Common Health Insurance Coverage for Therapy
While it’s becoming more common for health insurance companies to cover mental health services, the language in their policies can be confusing. While your health insurance plan may state that it covers mental health care, you might also need to prove that you have a mental illness for treatment to be one of your essential health benefits. You may feel uncomfortable disclosing your mental health disorders to an insurance company in order to receive coverage, and this is one way an insurance company can avoid paying for your mental health and substance abuse treatment.
Dealing with insurance companies over mental health services isn’t all bad, however. Due to laws that require mental health parity, your insurance company can’t force you to pay more for mental health services than for services you’d receive from any of your other doctors. If your mental health provider proves your treatment is medically necessary, insurance companies will normally cover all your visits and any prescribed medication.
Does Insurance Cover Mental Health Services and Which Plans Does it Cover?
The Mental Health Parity and Addiction Equity Act require health plans that offer coverage for medical and surgical services to offer similar coverage for a range of mental health disorder services. This includes coverage for someone who has a substance use disorder and requires support services to help them remain sober after admission to a rehabilitation program. A person’s out-of-pocket costs, such as copays for sessions, should be about the same as what they’d pay to see a medical specialist.
Insurance plans vary greatly, so it’s important to read the fine print to see how your mental health coverage is administered through your plan. While healthcare reform law has greatly expanded access to behavioral health services, your health plan may still have limitations.
Employer-Sponsored Coverage
Employer-sponsored health coverage is the most common way people obtain health insurance. If you work for a business that has over 50 employees, your mental health and substance abuse coverage is often included in what the government considers medically necessary services. If your insurance plan covers medical and surgical benefits and mental health care, you can’t be charged more for your therapy costs, substance abuse services, and psychotherapy than you would if you received medical care through your primary care physician.
The law doesn’t require employers to cover mental health services, but most employers with over 50 employees cover it. Businesses with fewer than 50 employees aren’t required to meet the same insurance standards as those with larger workforces. You may need to obtain private health coverage if you work for a smaller company that doesn’t offer comprehensive health benefits that include access to mental health care.
Affordable Care Act
You’re free to use the health insurance marketplace in your state to apply for insurance, regardless of whether you’re already enrolled in an employer-sponsored plan. The Affordable Care Act requires insurance plans on the marketplace to treat mental health and substance abuse treatment as essential health benefits. For this reason, mental health benefits are a cornerstone of marketplace coverage.
Many people choose to seek coverage from the health insurance marketplace exclusively to ensure they have access to mental health professionals and substance use disorder services as part of their coverage. You don’t need to have a diagnosed mental health condition to be covered, and insurance companies aren’t allowed to deny you coverage for any preexisting condition. If you need mental health help and your employer’s health plan doesn’t offer coverage, consider moving to a marketplace plan instead.
You could qualify for subsidized coverage if your income falls within the bracket for the Advanced Premium Tax Credit. You’re able to use the credit to reduce your monthly premium or write off the cost of your health insurance on your taxes at the end of the year.
Pay attention to the open enrollment period for coverage. Most state marketplaces have an open enrollment period that lasts from November 1 to January 1. Unless you have special circumstances that qualify you for a special enrollment period, you’re required to enroll in your health insurance plan during this window.
Medicaid is a state-run health insurance program that offers insurance coverage for those who couldn’t afford it otherwise. If your income is under the state threshold, you may obtain physical health and mental health coverage through Medicaid. All Medicaid coverage is required to consider mental health services as an essential health benefit, so access to a mental health professional or substance abuse program is covered.
How to Access Mental Health Services
If you need mental health and substance abuse treatment, make sure to review your health insurance policy to see what’s covered. The best way to reduce your out-of-pocket expenses is to make sure the psychologist or therapist you wish to see is included in your plan’s in-network providers list. Health insurance plans that cover mental health services may also list some rehabilitation programs they prefer to cover.
Mental Health and Addiction
Many people who suffer from a substance abuse problem may also have an underlying mental health condition that’s preventing them from making the progress they desire. This is referred to as a dual diagnosis, and it’s important to acknowledge the connection between our mental health and behavioral patterns that lead us to substance abuse.
The ways a licensed psychiatrist can help you during your recovery from a substance abuse disorder include the following:
Assessing Your Mental Health Issues
You might not be aware of mental health problems that are keeping you from leading the life you want. A psychiatrist can diagnose any mental health disorders you have and provide a treatment plan, which may include medications to treat anxiety, bipolar depression, sleep disorders or obsessive-compulsive behaviors that contribute to your addiction.
Adjusting Treatment to Your Unique Needs
Your mental health concerns are important when determining the best way to ensure a successful recovery. Working with a psychiatrist can reduce your chance of relapse because your treatment plan revolves around your needs and aspirations.
Continued Support After Your Initial Recovery
Identifying your mental health conditions allows you to pursue ongoing care. Recognizing when your mental health is interfering with your progress may keep you from returning to your addiction by making you reach out when you know you need support. Mental health professionals can help you learn coping mechanisms and direct you to vital resources when the struggle gets too intense.
How Camelback Recovery Can Help
Camelback Recovery offers services that are designed to address the root causes of addiction and help you develop skills you can use to remain sober after you’ve completed your treatment program. Our mental health facility in Phoenix, Arizona offers a luxurious break from the world so you can focus on your wellness and recovery.
To learn more, call us at 602-466-9880. If you’d like to know if your insurance company covers our services, fill out our contact form and we’ll let you know if you’re covered. We accept insurance from most major providers like Aetna, Cigna, and United Healthcare.
