Insurance For Your Mental Health:

Are You Covered?

Questions you need to ask...

In an age when managed care is taking over many insurance plans it is more important than ever to be informed about your mental health coverage. You don't want to find out too late that you coverage is lacking.

Most people do not understand their coverage. Insurance companies and employers are not going to concern themselves if you have inadequate coverage, because low coverage means low premiums. What many employers do not realize is that it is COST EFFECTIVE for them to make sure you are mentally healthy.

You should fully understand your mental health coverage in order to ensure that you and your family are adequately covered. When you talk to your employer or insurance agent, the following information will allow you to discuss these very important issues in an informed way.

FACT: Studies have shown that mental health care can improve a person's overall health while reducing medical over-utilization by up to 75%. (1)

FACT: Employers who provide an appropriate level of mental health coverage have better employee functioning. As a result, absenteeism is reduced by 49%, there is a 48% decrease in the number of physician office visits, and there are fewer costs related to expensive inpatient psychiatric care. (up to 41% fewer costs). (1)

FACT: Making outpatient mental health coverage readily available reduces overall health care expenditures.

Questions to ask your insurance agent or employer...

If you need mental health care, can you choose your own therapist?

Does your insurance plan allow you to chose a therapist recommended by a friend or your family doctor?

When questioned about the proposed national health care plan, Americans stated very clearly that they want to be able to choose their own physician and their own mental health specialist.

If you want to see a particular therapist, is that option available to you or will you be forced to see the provider chosen by the insurance company?

Will you be able to see your therapist on a regular basis or will you be seen by a different therapist at each visit?

Will your company allow your therapist to join the insurance group's list of providers?

How many counseling sessions are you allowed?

Are you limited to a specific number of therapy sessions per year or per problem (such as 5 sessions) or can you receive as much counseling as the therapist deems necessary? Is there a "cap" or limit on the amount of therapeutic assistance you can receive?

Who determines the treatment decisions, your insurance company or your therapist?

What if you need more help than your plan allows?

Who is covered by your insurance plan?

If you are having marital or other relationship problems, can you receive treatment to help relieve some pressure or stress resulting from that strained relationship? If therapy is required for your child, will that be covered? Does your insurance provide for family therapy?

Is drug detoxification covered?

If you need help to stop drinking or to stop taking a drug to which you may be addicted will this be covered by your insurance? Is coverage provided on an inpatient basis? Are you eligible for an inpatient drug rehabilitation program?

Are you covered for depression and anxiety even though you don't need to be hospitalized?

Do you need to have a specific "acceptable" diagnosis in order to obtain insurance reimbursement? Are only certain "severe" diagnoses approved by your insurance carrier?

Are psychotropic (prescribed for your mental health) medications covered?

Does your insurance cover medication needed for mental disorders (which you may require on a long-term basis)? Are you covered only for generic drugs or particular medications even if your doctor insists on specific brand name prescriptions?

Do you have to be referred to a therapist by a general practitioner?

If you decide that you need to see a therapist, can you go directly to the therapist's office or do you have to obtain approval from your general practitioner or some other gatekeeper? What happens if you don't have a primary care physician?

Do you have to pay part of the cost yourself (a co-payment)?

Are you reimbursed directly or is the therapist paid by the insurance company? Find out who pays, who is reimbursed, and how long this process takes.

What is your deductible (the amount you have to pay before your insurance starts to pay)?

What are your out-of pockets expenses before your insurance begins to pay your bills?

Is psychological testing covered?

Your therapist may feel that testing is required. If so, will this be covered or will you have to pay for it yourself?

Is a second opinion covered by your insurance?

If you are not satisfied with your therapist's diagnosis or treatment plan, can you see another therapist to obtain consultation?

What happens if you miss work due to a mental illness or a detoxification program?

Is your workplace and insurance plan supportive of your mental health? Is access to help made easy? Will your employer penalize you for seeking mental health treatment?

Is group counseling covered?

This may be productive and cost-effective way for you to obtain therapy, but is it covered by your plan?

If you have an Employee Assistance Program (EAP) where you work, what happens when you have used up your allotted number of counseling sessions?

Your employer may provide an EAP in addition to or instead of mental health insurance. As a part of this program, you may be allowed a limited number of counseling sessions with a specified therapist. Check your medical insurance to see if it covers counseling beyond any limited coverage you may have through your EAP.

*****

The time to figure out if you have adequate insurance is before you actually require the insurance.

Understanding the type and scope of your mental health coverage is only the first step. You should also demand adequate coverage from those responsible for your well-being. Only then can you be assured of your own mental health and the health of your loved ones.

For help selecting a therapist anywhere in the US and Canada call

1-800-THERAPIST

1-800-843-7274

(1) taken from "The Cost Savings of Mental Health Services" EAP Digest by Ron Lechnyr. Ph.D. November/December 1993

COPYRIGHT 1998 DR. KEVIN GROLD 1-800-therapist