Insurance and Uninsured

Health insurance is a rabbit trail of policies, loopholes, and general aggravation. Each policy is different from one another and what is covered, deductibles, and copays all vary greatly.

In 2008 the Mental Health Parity Law was passed which requires coverage of mental health, behavioral health, and substance-use services to be comparable to physical health coverage. This means that insurers must treat prices equally, so if an office copay is $20, you can expect a mental health office copay to also be $20. This was further advanced with the passing of the Affordable Care Act, which expanded mental health coverage for most insurances.

Most insurances are required by law to cover mental health services. If you are unsure about your services, your insurance company is also required by law to provide an easy-to-understand summary about your benefits.

How can I find out what my benefits are?

If you have a recent copy of your benefits booklet, it should outline the benefits in mental, behavioral, and substance-abuse services.

Another easy way to find out is to call the customer service phone number on the back of your insurance card. Some insurance cards have a dedicated line for mental health services.

More and more insurances are also offering online profiles where you can digitally access your benefits guide.

When inquiring about mental health benefits, be sure to ask about deductibles and copays.

How can I find services inside of my network?

Most practices will list what insurances they accept on their websites, or you can find out by calling a practice directly.

Alternatively, may insurances will offer a list of practices on their website. Again, calling the customer service number on the back of your insurance card is also a great way to get in-network referrals.

What if I can’t afford my treatment?

Many practices offer sliding-fee scales, meaning they will charge your sessions based on your income. The less you make, the less you pay. Other practices, especially nonprofits, may offer deeply discounted or even free sessions. Additionally, many employers offer Employee Assistance Program (EAP) benefits, which can be used to cover a certain number of sessions for free. EAP benefits usually have to be pre-approved through your employer and/or insurance.

Medicare

Medicare is a federal health insurance program for people who are 65 or older or who live with disability. Medicare is broken into three pieces – part A, B, and D (Part C is not a separate benefit).

Part A helps cover Hospital Insurance, such as inpatient hospitalization, and covers things like your room, meals, nursing care, and supplies.

Part B is Medical Insurance, which helps to cover most outpatient services, such as regular visits with a psychiatrist or doctor. Part B may also partially cover partial hospitalization services.

Part D is prescription drug coverage, which helps to cover the costs associated with medication

To view a full government booklet on mental health services under Medicare, click here.

Medicaid and CHIP

Medicaid is the social health care program in the United States for low income families. CHIP stands for Children’s Health Insurance Program and is a component of Medicaid. Medicaid is managed by the state, thus the coverage and eligibility is different for each state. All state Medicaid programs provide some mental health services, such as counseling, therapy, medication, social work, case management, and addictions treatment. While each state determines which services to provide, Medicaid does require a variety of medically necessary services including mental health. In addition, Medicaid must meet the Mental Health and Substance Abuse Parity requirements.

For more information on Medicaid coverage for mental health, click here.

TriCare

Tricare, previously known as the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS) is a health care program of the US Department of Defense Military Health System. Tricare provides health benefits for military, veterans, their dependents, and some members of the reserves.

For more information on Tricare coverage for mental health, click here.

Self-Insured Corporations

A self-insured or self-funded plan is one where an employer pays out of pocket for providing health care to employees as opposed to purchasing a plan through another insurance provider. Depending on the size of the employer, this may be more cost efficient for companies because health care costs are paid per claim as opposed to paying a fixed premium set by an insurance company. Self-insured plans are still required to follow regulations outlined by the Employee Retirement Income Security Act (ERISA), Health Insurance Portability and Accountability Act (HIPAA), Consolidated Omnibus Budget Reconciliation Act (COBRA), the Americans with Disabilities Act (ADA), the Pregnancy Discrimination Act, the Age Discrimination in Employment Act, the Civil Rights Act, the Mental Health Parity and Addiction Equity Act (MHPAEA) and various budget reconciliation acts such as Tax Equity and Fiscal Responsibility Act (TEFRA), Deficit Reduction Act (DEFRA), and Economic Recovery Tax Act (ERTA).

Since self-funded plans are required to abide by MHPAEA, any policy beginning on or after January 1 2014 is required to include coverage of mental health and substance abuse disorder benefits, and that coverage must comply with federal parity requirements.

Employer Guide for Compliance with the Mental Health Parity and Addiction Equity Act

COBRA Benefits

COBRA stands for the Consolidated Omnibus Budget Reconciliation Act. It gives employees the right to pay insurance premiums in order to maintain the coverage offered by their employer after reducing work hours, quitting their job, or losing their job.

COBRA is not an insurance plan – rather, it is the ability to continue paying for the insurance your employer offered to you. Due to this, mental health coverage depends on the insurance plan. To learn more about what mental health benefits are covered, contact the HR department at your previous employer.

Prescription Drug Coverage

Insurance plans generally cover some medications, usually those on an approved list. If a medication that you need to treat a mental health problem is not on the approved list, utilize your insurance’s exceptions process to request covering a medication that is not normally covered by your plan. Contact your insurance company to find out how to begin this process. Some insurances will cover the medication until a decision is made, so ask to see if this is a possibility. If your insurance company denies the exception, you have the right to appeal the decision through a third party. Click here to learn more about the appeals process.

If you cannot afford prescription copays, you have several options to try. Ask your doctor or pharmacist if there is a generic version of your prescription that costs less. Additionally, some hospitals and pharmacies will waive copays for individuals with low income. The policy varies by location, so the best thing to do is to simply ask if copays can be waived or discounted.

What can I do if I have no insurance?

Seeking help without insurance is difficult but not impossible. Many community services exist that can help at low or no cost to individuals who are under or uninsured. Begin by calling your county mental health services to ask about services available for the uninsured.
In addition, here are some free services that you can use right away to seek help:

Hotlines:
Speak to a trained crisis counselor. While not therapists, hotline workers can be a source of comfort, strength, and advice during hard times.

National Suicide Prevention Lifeline: 988

Crisis Text Line: Send “HOME” message to 741-741

Chatline: ImAlive, National Suicide Prevention Lifeline, Crisis Chat

Find a Free Clinic:

The Partnership for Prescription Assistance has a searchable database of free clinics. Just type in your zip code to find a free clinic near you. Click here to access the database.

The US department of health and human resources also has a database of free clinics in your area. Click here to access the database.

HealthCentral has an excellent article on more ways to get assistance paying for treatment and medications. Click here to access the article.

How can I file a complaint against my insurance?

Click here to file a complaint directly with your state insurance department.

The Kennedy Forum is also a great website to assist in filing parity complaints. Check them out here.