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 when dealing with your typical cold or flu alone, so understanding mental health coverages can be much more difficult. When wondering if your policy will cover any kind of therapy, you should first check your 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 you are 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 you cannot be denied coverage if your mental health condition was pre-existing before you bought your insurance plan. Additionally, insurers cannot place an annual or lifetime limit on their amount spent on mental health services.
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When selecting a psychologist or therapist, it is essential to remember that not all therapists accept every plan. The easiest way to find a provider that will take your selected insurance plan is to search for a provider on the insurance company’s website.
Suppose you have a pre-existing mental health provider you wish to utilize. In that case, many practitioners are willing to file for payment regardless of your insurance company. Still, they may require full payment from you upfront and reimburse you once your insurance has been paid.
Some therapists offer sliding scale cash pay prices dependent upon the patient’s income, so your desired therapist’s cash pay price may be less than your potential insurance copay for therapy. Check with your provider to see if they offer this type of pricing.
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