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When shopping for medical health insurance, be sure your policy has the coverage you need for your mental health needs. In addition, you may not need mental health coverage at this time, but you do not know what could happen in the future. Be sure you have complete health insurance coverage for whatever may arise.
What do I need to look for in my health insurance policy?
According to the Mental Health America there are multiple factors you should look for in your health insurance policy for mental health coverage.
- First, you should review the types of mental health treatment and services that are covered under your health insurance plan. You can do this by reviewing your policy and calling the health insurance company for clarification.
- Next, you should review how much is covered for mental health treatment and services under your health insurance plan. You should verify this by calling your insurance company after you have read your policy.
- Lastly, you should check and see how you have to go about getting mental health treatment and services. If you have to go through multiple steps to get the help you need, it might not be a worthwhile plan. Steps should be minimal like a phone call or a referral at the most.
Make sure you get the name of the person you speak with so that you can call them back if the mental health care providers explain that the requirements for help is different than what your insurance company is explaining.
What kinds of questions do I need to ask regarding my treatment?
Be sure and verify with your insurance company whether you need a referral or authorization from the insurance company itself for treatment. You may also want to find out if you need a new referral or authorization for each visit or treatment.
Once this has been determined, find out how many visits will be covered under the policy or for how long the treatment will be covered. If your treatment requires being admitted to a hospital or treatment center, be sure and find out how many days your insurance company will cover.
What about caps on my mental health care?
You will also need to verify whether there are any caps on your mental health care portion of your insurance policy. Due to Health Care Reform, caps on health care will be done away with but not until 2014 for adults according to The Roanoke Times. Caps on insurance policies for children have already been removed.
What is the difference between an in-network and out-of-network mental health care provider?
The difference between an in-network and out-of-network mental health care provider can mean a lot to your wallet. An in-network provider will be covered under your insurance policy at a greater amount than an out-of-network provider will. Some insurance plans will not cover an out-of-network provider at all.
It is very important to verify the list of in-network providers. Most insurance companies have these providers listed on their websites or in a paper directory. You can also phone the insurance company to obtain a list of in-network providers.
What about pre-existing conditions?
Many mental health or behavioral health conditions are pre-existing depending on when the patient was diagnosed. Up until recently, pre-existing health conditions were often not covered under health insurance policies. However, with Health Care Reform, insurance companies will no longer be able to deny or not cover conditions if they are considered pre-existing conditions.
However, there are certain conditions that a health insurance policy might not cover. You should verify this list when comparing insurance companies and policies. If you know you have a mental health condition, be sure yours is covered under the policy.
What about prescription benefits?
You should always verify the mental health prescription drug benefits under your health insurance plan. You may not know the exact names of mental health prescription drugs, but you can ask for the formulary from the health insurance companyto at least review what is covered. If you know the medications you need, be sure and verify that they are covered on the health insurance company’s formulary.
You can review mental health care benefits with online health insurance now by entering your zip code into the toolbox on this page!