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Understanding Your Health Insurance

Since 2008, America has witnessed monumental changes in the economy, the government, and the environment. Health insurance plan adjustments have lent to an overwhelming transformation, making it ever more complicated to choose the best insurance option.

The right benefits protect us in the case of a medical emergency, and we need to make sure that the changing medical regulations are still relevant to our needs.

Does My Insurance Cover Mental Health and Substance Abuse Treatment?
Did you know that most health insurance plans are now required by law to cover mental health and substance abuse treatment? As of 2014, as part of the Affordable Care Act, more Americans than ever before have access to mental health care benefits. This includes preventive services like depression screenings and pediatric behavioral assessments, as well as various therapies like Cognitive Behavioral Therapy, Group Counseling, and Family Therapy. Also included are inpatient and outpatient substance abuse treatment, and rehabilitative services to support people with behavioral health challenges.

The Mental Health Parity Act and Addiction Equity Act
The Mental Health Parity Act and Addiction Equity Act, passed in 2008, requires private health insurance plans to provide equal amounts of mental health benefits as provided for medical/surgical benefits. However, not all plans are subject to parity, and it is the policyholder’s responsibility to find out if their plan offers this benefit.

Knowing what your insurance plan covers before you have to use it will avoid surprise bills and denial of care.

Make a List of Questions
Understanding your current benefits is a good idea whether you’re currently seeking mental health services or not.

Compile a list of questions you want answered in order to determine when and how to use your benefits. Some questions may include:

  • How much am I required to pay out-of-pocket?
  • What is my deductible?
  • Which benefits are included, and what is not covered?
  • Does my plan cover conditions associated with mental health and addiction, such as depression and alcohol dependency?
  • How long are my benefits good for?
  • Which specialists participate under my plan?
  • Are reviews necessary and what is the process?
  • Which services require authorization?
  • Who are my in-network versus out-of-network providers?
  • Why does my policy state that I have 30 days of mental health insurance?

Key Health Insurance Terms to Know

Prior to conducting an in-depth analysis of your benefits, it is important to understand the terminology. Here are a few terms you should familiarize yourself with:

  • Deductible: the amount you are responsible for paying to cover medical expenses before your insurance starts to pay in a given year.
  • Coinsurance: the shared costs between you and your insurance provider. Usually a ratio, for example, 80/20 means that the insurance provider will pay up to 80%, and you would be responsible for 20%. Not all plans have coinsurance.
  • Copayment: a fixed amount paid at the time of a doctor visit or prescription refill.
  • Out-of-pocket maximum: the amount you are responsible for paying for covered medical expenses in a given year until your insurance starts to pay 100% of covered expenses, after meeting your deductible and coinsurance.
  • In-network vs. out-of-network: If doctors, facilities, and specialists are listed as in-network under your plan, it means that they participate under your plan. If the doctors you wish to pursue are not on this list, they are considered out-of-network, and medical expenses will not be covered.

How to Get Your Questions Answered

Get your questions answered today in order to be prepared for tomorrow. Call your health care provider to speak to a representative and ask your list of questions.

You can also browse their online information specific to your plan to learn what types of mental health care services are covered and at what amounts.

You can even discuss your plan with your employer’s HR department in person.

You may be pleasantly surprised to learn what your coverage offers, which may enable you or a family member to get the services needed to get through any number of mental health and substance abuse issues.

Get Help Without Worry of Uncertainty

“Our goal is to make each patient’s stay successful and that starts with helping them get the care they need, while staying within their insurance restrictions.”
-Francisco Abreu, Carrier Clinic®

At Carrier Clinic®, a Central Jersey behavioral health center, we want to be sure all of our patients and prospective patients understand exactly what their health insurance covers for their psychiatric or substance abuse treatment. Seeking help is perhaps the most critically important step in the recovery process, which is why we do not want that decision clouded by insurance uncertainties.

If you’ve been waiting to talk to someone about anxiety or your loved one’s substance abuse condition, now is the time to take advantage of the Mental Health Parity Act and Affordable Care Act healthcare changes.

Carrier Clinic® works with many insurance providers. To learn more about admissions and how to work with your insurance carrier, contact our Access Center (available 24×7).

Related Topic
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