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Mental Health Insurance

Mental Health Insurance what is it actually

Mental health insurance covers various problems of the mind such as anxiety, depression, treatment of substance abuse, and behavior disorders among children. Although mental health coverage might be included under medical insurance, it is important to note that not all health insurance plans cover mental health problems. It might be come as a separate policy similar to vision or dental plans. In case one has a group health plan and it includes a mental health benefit, the federal parity law needs the lifetime and annual parity limits for mental ailments and physical ailments to be the same.

How does one use mental health coverage

It is dependent on the type of insurance that an individual has taken. If he is part of an HMO, he has to get approval first of all. The insurance company will approve a certain number of visits which is normally 1 to 10 to a mental health therapist. Majority of the insurance company give a list of providers present in their network. If the insured has taken a fee-for-service or PPO insurance, there is no need to get in touch with the insurance company initially. It is enough to call a provider directly in order to schedule an appointment and check up if there is mental health insurance coverage. In case the answer is in affirmative then various questions might come that are : (i) what services are paid for by the plan (ii) is there a necessity to have a mental health treatment authorized before time (iii) Are there restrictions on the number of visits (iv) Are there some diagnoses or pre-conditions which is outside the purview of the insurance plan (vi) Is there a annual limit for mental health coverage or a lifetime dollar limit (vii) Are there preferred list of providers or a network which must be used. (viii) And finally what is the amount of co-payment.

In case one does not have a mental health insurance he has to pay for the services himself. The fees for mental health insurance differ, however a lot of providers have different plans which charge fees as per ones income. In the event the employer doesnt offer health insurance or in case the insurance does not cover mental health insurance, one has to purchase an individual policy. Prior to buying an insurance policy, one must ascertain its scope of coverage i.e. what it will cover and will not.

What one can expect from the insurance plan

The various insurance coverage in case of mental health (MH) and substance abuse (SA) benefits varies across plans, employers and is different for different states in America. Under the State laws there might be a necessity to provide a standard, minimal offering of MH and/or SA benefits even though insurers are at liberty to provide additional coverage. On the whole mental health benefits do not prove to be as extensive as medical or surgical benefits and requires more deductibles and co-payments apart from any regular fixed payments.

Circumstances that induce one to take a mental health insurance

If one is leading a stressful life or going through a job-related tension that is disrupting an individuals daily life then he is definitely a candidate for a mental health insurance. Besides, in case a routine use of legal or illegal substances is adversely affecting ones health and his daily life, one must look for treatment for substance abuse. While looking for treatment for mental health or substance abuse, one may talk with a case manager of a insurance company or treatment facility. A case manager depending on the type of ones insurance might in association with the healthcare provider, make an assessment of the healthcare needs and refer to a specialist and manage the services that one is going to receive and follow up on the treatment.

The pros and cons of Mental Health Insurance

(i) Number of visits:

Normally patients are covered for 20 to 30 sessions per year and are supposed to pay 20% to 50% of the Bill. Depending on the place of residence and the qualifications of the therapist, one can expect to pay out $ 75 to $175 per session. Medicare, which is the federal health insurance program meant for US citizens above 65 years of age covers 50% of the most out- patient care without any restrictions on the number of visits.

(ii) Plan coverage:

Depending on the provider, leading insurance companies cover problems ranging from anxiety and depression to relationship problems as also social phobias.

(iii) Choice of Physician

Choosing a physical depends on the insurance plan. In case one has a Health Maintenance Organization (HMO) or a prepaid health plan, one might be able to select from a small group of healthcare professionals. These professionals might be included in a network of providers wherein it might not be possible to consult a therapist of ones choice. In case one is included under a Point of Service (POS) plan which is also called as a Fee for Service Plan, one can visit any doctor and the insurance company will cover the fees. In case of a Preferred Provider Organization (PPO) plan, one has to again select from a narrow number of providers, however it is possible to get fees partly covered for providers who remain out of the network. However, it has to be remembered that the out-of-pocket payments will be higher.

(iv) As regards drug and medication coverage

In case of medicines, insurance plans need a co-payment which can go rock-bottom $5 in case of a generic prescription and $10 or higher for a branded medicine.

One demerit of some mental health plan is a low lifetime maximum or a low annual dollar amount which can be used in case of mental health care which implies that once this amount is used, the plan coverage expires. The parent is responsible for payment of the non-covered bill. In case the child/adolescent requires continued care, one might need to look for help from the state public mental health system. This generally implies changing doctors that might disturb the care of the child.

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