Using Health Insurance For Mental Health Care

Mental health care services are an important part of holistic health. According to the Anxiety and Depression Association of America, nearly one in five Americans live with an anxiety disorder and 16 million adults in the United States live with depression. These conditions are associated with more doctor’s office and hospital visits, increased risk of heart attack and a weakened immune system.

The good news is that if you have an ACA compliant health insurance plan, then your health insurance covers mental health care. This removes a significant roadblock to treatment, which can be pricey. The bad news is that using your health insurance to cover mental health services may be more difficult than you would expect.

Benefits of Using Health Insurance for Mental Health Services

Reduced Medication Costs

Many people living with mental health disorders benefit from prescription drug therapy. Even if you pay for your therapy sessions out of pocket, your health insurance policy still covers prescription medications. If you aren’t asked to pay a copay for the visit, you should only have to pay a discounted “network” rate, instead of the full normal rate.

Pre-existing Conditions Do Not Affect Coverage

Even if you were diagnosed with a condition like bipolar disorder or generalized anxiety disorder decades ago, your health insurance provider cannot deny you coverage for treatment. Under the ACA, pre-existing conditions must be covered.

Our recommendation is to make sure you are seeing contracted providers if possible. If you have an HMO, you won’t really have a choice because the HMO requires you to use their providers. If you want to see a specific therapist, and they are not in your plans network, you must pay the full cost yourself.

Drawbacks of Using Health Insurance for Mental Health Services

Lack of Long-Term Documentation Privacy

Any documented health treatment that you receive (that is filed through your health insurance company) becomes part of your permanent medical file. If your health insurance company audited your records to prevent fraud, they would have access to all the details about what was discussed in each counseling session. This lack of privacy makes therapists hesitant to accept health insurance, and patients hesitant to file claims.

Difficulty Finding a Therapist

Health insurance companies and therapists have a difficult relationship, and in most cases, working with health insurance companies results in therapists receiving less money and taking on a lot more administrative work. For this reason, many therapists do not accept health insurance. Those that do, typically have very long wait times, which may not be practical when dealing with a mental health issue. We currently have a shortage of mental health providers here in Nevada, which only compounds the problem.​

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The Requirement for a Specific Diagnosis

In most cases, health insurance companies only cover medically necessary services, which require a specific diagnosis. However, many people seek mental health services for reasons not defined by a specific mental health condition. Unless you are receiving mental health services for a particular disorder like bipolar or schizophrenia, you may have a hard time getting your health insurance to cover your sessions. Call your insurance plan for details on what mental health services are actually covered.

How Your Health Insurance Policy Handles Mental Health Services

When it comes to your well-being and quality of life, mental health is just as important as physical health. Unfortunately, only about 40% of people who need mental health services get treatment. One of the biggest roadblocks to treatment is that many believe that getting help from a mental health professional would be too costly. At one point, that was probably true. However, because of a 2008 law called the mental health parity law, health insurance companies must provide mental health coverage that is comparable to physical health coverage.​