Mental Health and Insurance

Dealing with health insurance can be extremely challenging, especially if you are already dealing with stress and worry concerning your mental health. Healthcare in the US can be very expensive, so choosing the right insurance plan is very important. Because some insurance plans don't cover mental health care, it's vital to confirm what your plan will cover if you seek mental health attention.

Since the passage of the mental health parity law in 2008 and the Affordable Care Act, most insurance plans now cover mental health care--however, non-ACA plans may not. This is a significant improvement compared to before these laws, but mental health coverage is still sometimes not as comprehensive as other coverage. Make sure you are familiar with an insurance plan's mental health care coverage before you purchase it.

Choosing an Insurance Plan

When choosing your insurance plan, be sure to ask the following questions:

  • How much should I expect to pay for each visit?
  • Is my provider covered under the insurance plan?
  • Is there coverage if I go to the student health center for treatment?
  • Does my plan cover treatment for substance abuse?
  • Does my plan cover me in case of attempted suicide?
  • Does my plan cover pre-existing conditions?

In addition to these questions, some insurance plans include limits on mental health coverage. For this reason, it's important to be aware of these limits before seeking treatment--or preferably, before purchasing your insurance plan. Common insurance limitations include:

  • Mental health conditions are not covered if treatment is sought at the student health center.
  • There is a maximum number of visits that are covered per year.
  • Your insurance plan may only cover a percentage of the cost of the visit.
  • Your plan may only cover M.D.s and D.O.s and not counselors/therapists/social workers.
  • Your plan may have exclusions on suicide and/or substance abuse.
  • Mental health benefits may have caps, which means that the plan will only cover a certain amount for inpatient or outpatient.

Additionally, some mental health professionals do not take insurance, so check to see what the insurance plan will pay for out of network providers. Other factors to keep in mind include:

  • Affordability. Compare and contract monthly premiums, deductibles, co-pays, and/or co-insurance to make sure that you are getting the best possible deal. In addition to how much you pay per month, consider how much money is needed to pay co-pays and co-insurance.
  • Availability of mental health professionals. Make sure that the health plan's network of providers includes a broad range of mental health professionals.
  • Coverage of prescription medications. If you are dealing with a pre-existing condition and have already found the right medication that helps you, make sure that whichever plan you choose covers that medication.

Every person is different and not everyone needs the same amount of insurance. Make a list of the type of care you anticipate needing, and make sure any insurance plan that you consider meets those needs.

Before Seeking Treatment

Before you seek treatment for mental health concerns, there are a few questions you should know the answers to. Review your insurance plan, and if possible, call your insurance company and ask the following questions:

  • Do I need a referral from my primary care physician to a mental health professional?
  • Do I need any pre-approval from the insurance company before I see a mental health professional?
  • Do I need to see a mental health professional who is on a list provided by my insurance company, or am I free to choose any qualified professional?

Understanding Your Policy

If you're having trouble understanding your insurance policy, ask someone from your doctor's office or a trusted friend to help explain the information. If you have private insurance, you can contact your state Insurance Department or state Insurance Commissioner's office to ask for help in understanding your policy. They can also help you in dealing with your insurance company if you are having a problem, and figure out whether your benefits follow the state mental health parity laws. These are laws that guarantee equal coverage for mental health conditions as for other conditions.

Once you've developed a working understanding of your health insurance policy, you're ready to seek treatment.

Return to our "Mental Health" section for more information and help