What A Typical Insurance Company Should Cover Under the Mental Health Parity Law

When looking after our well-being, mental health is just as important as physical health. However, insurance companies don’t always see it this way. A while back, lots of insurance organizations focused more on physical health coverage than mental health coverage. In 2008, a mental health law in the United States was passed and requires the coverage of medical services for mental health, substance abuse problems, and behavioral health to be similar to physical health coverage. This was known as the Mental Health Parity Act. Yet a lot of people are still not aware that this law exists and how it can help them. This guide has been designed to help you understand everything about mental health coverage under the mental health law.

What Does The Mental Health Parity Act Do?

This law requires all health insurance companies to treat mental health, substance abuse, teen treatment center, and behavioral problems health coverage similarly to other physical health coverage such as surgical or medical coverage. For example, health insurance companies are not allowed to charge more for a copay for visits to a mental health specialist than it charges for medical visits. The MHPA also ensures that non-financial health treatment limits are covered. For example, a while back mental health patients were limited in the number of visits they could have in a year. This law has removed such limits. However, it does not restrict insurance companies from setting limitations on mental health treatments that are deemed medically unnecessary.

What Health Plans Does the Mental Health Law Affect?

The Mental Health Law generally applies to these types of health insurance:

– Employer-sponsored health Coverage for organizations that have 50 or more employees.
– Children’s health insurance programs that cover places like Polaris Teen Center.
– Coverage acquired through health insurance exchanges created under the health care reform law known as the Affordable Care Act or Obamacare.
– Most Medicaid-related programs.

Some other types of government programs and plans are exempted from this law. For example, Medicare is not subject to the MHPA.
How to Know if an Insurance Plan Provides Mental Coverage
Check the description of the benefits of your plan. It should have information concerning mental health, substance abuse, or behavioral problems coverage. If you are still unsure or the information provided is not clear you can contact your insurance company directly or ask your human resources representative.

Are All Mental Health Issues Covered by Mental Health Law?

The federal mental health law applies to all mental health and substance use disorder issues covered by a health insurance plan. However, health insurance plans can specifically choose to omit certain treatments. Any omissions should be made clear to you in the health plan’s description of mental health benefits.
All Insurance plans are expected to cover the following:

– Behavioral health treatment like psychotherapy and counseling.
– Substance abuse disorder treatment.
– Mental and behavioral health inpatient services.

Specific types of behavioral benefits will sometimes depend on the state of a patient and the health plan which was chosen. Pre-existing mental issues are also expected to be covered and there should be no limits on spending. Coverage for the treatment of all mental health conditions that were pre-existing are expected to start when coverage starts as well.

mental health doctor

Things to Consider When Using Your Mental Health Coverage

– Ensure that your coverage makes use of provider networks. Normally, patients are required to pay extra when visiting an out-of-network provider. Call your insurance company or visit the company’s website for a list of in-network providers.

– Ask about co-payments – A co-pay is a charge which an insurance company will require you to pay out of pocket for a specific service offered. In past years, co-pays for mental health visits were somewhat greater than those for medical health visits, but now they should be equal.

– Find out about deductibles – A deductible is an amount required to be paid out of pocket before your respective health insurance will make any payment on your behalf. Depending on the deductible, you may end up paying $500 – $5000 from your own pocket before your insurance company makes any payments on claims. The Mental Health Parity Act and Affordable Care Act ensure that deductibles apply equally to both mental and physical health coverage.

– Talk to your mental health care provider – When you are calling to make an appointment with a mental health specialist, find out if he or she accepts your insurance. Also, make sure that you ask whether your insurance company will be billed directly or if you will need to pay in full then submit a claim to your insurance company in order to be reimbursed.

What Should You Do if Your Insurance Company Appears to Be Violating the Mental Health Law?

If you think your health plan is not complying with the MHPA, inquire from your human resources department for a complete summary of the benefits you are supposed to receive to fully understand your coverage. If you don’t have a human resources department or if your health insurance is not provided by your employer, contact your insurance company directly. If you still have any questions that are unanswered or you wish to file a complaint, you can go to the Department of Labor Employee’s Benefits Security Administration (EBSA) customer’s assistance page and from there; you can choose to click on ‘Submit a Complaint’, ‘Report a Problem’, or ‘Ask a Question’. You can also call the EBSA customer help line at 866-444-3272.