Does Insurance Cover Therapy? A Health Insurance View

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The mental health care industry is a billion-dollar industry, and the reason isn’t far-fetched. Millions of Americans live with a psychological health issue and therefore, have a need for health care. And for those who might need therapy, they often ask does my insurance cover therapy?.

Millions of people have a need for either routine medical check-up or extensive treatment of an ailment.

Bearing in mind how expensive medicare can be, millions of Americans buy health insurance to reduce their out-of-pocket expenses for health-related issues.

Be that as it may, some still encounter issues using their health insurance, especially for mental or psychological well-being.

It is for this reason that we bring you this article.

In this article, we will tell you what services your health insurance can cover. All that you need to know with regards to health insurance covering therapy.

According to the National Alliance on Mental Illness, one in 25 American adults experiences serious mental illness that obstructs major life activities each year.

This lends credence to the statistics of the National Network Of Depression Centers that believe that…

Less than half of the 16million American adults who experience major depression receive treatment.

While one in five of the 44million people who live with mental health conditions are not getting professional care, according to Mental Health America.

Does My Insurance Cover Therapy

Therapy is no doubt expensive but very vital for mental wellness.

And people are often unsure about whether a health plan covers their therapy, or how much of their therapy health insurance can cover.

Oftentimes than not, they don’t even know how to find out.

It is excruciating to see so many people live without mental care even when health insurance has greatly improved.

It has improved so much as to cover mental health in the last decade.

The Mental Health Parity, Addiction Equity, and the Affordable Care Act have helped make many health plans to statutorily provide coverage for mental purposes.

To find out if your health plan covers your therapy, you will need to do a little research on your health plans’ website.

It is likely that they have the things your plan covers spelled out on their website.

To find the web address, look at your health insurance card. When you do gain access to the website, you may need to create an online account.

If you are able to do this, you will find out if your insurance does cover your therapy.

If however, you are still confused or need clarification even after visiting the website, contact your Human Resources manager who is in a better position to take you through your plan.

You could also give your insurance company a call and ask about coverage for mental health.

Does Insurance Cover Therapy?

While some insurance cover therapy, some do not. However, for the health plans that do cover therapy, they are obligated by law, to offer the same benefits.

Benefits equivalent to that of medical coverage.

That is to say that mental health patients must not be shortchanged.

So, if a health plan charges $45 for a copay on medical care plans, it must charge the same copay for mental health plans.

However, it is important to understand that the parity law does not apply to all health plans. State government teachers are a good example.

The Following People Must Obey the Parity Rule While providing a health plan

  • Employer-sponsored health plans for companies with 50 or more employees
  • Individual health plans purchased through the health insurance exchanges created under the Affordable Care Act
  • Children’s Health Insurance Program

However, the law does not apply to smaller firms with employees lower than 50.

And it also does not cover some state plans.

It is worthy of note that Lynn Bufka, a top executive of Practice Research and Policy at the American Psychological Association stated that medicare is not under the Parity Law. But however, might cover mental health benefits.

Is there a deductible?

Before we go on to answer this let’s first understand what deductible means.

A deductible is an amount of money that you are responsible for paying toward an insured loss. Generally speaking, the larger the deductible, the less you pay in premiums for an insurance policy.

A   deductible can be either a specific dollar amount or a percentage of the total amount of insurance on a policy.

For your health insurance, you might be required to pay a specific amount of money as deductible. After this, the insurance company will start paying benefits. The deductible fee is usually dependent on your insurance plan.

If you have however finished paying your deductibles through copays during doctors’ visits or paying for prescription drugs, you might not need to pay deductibles again. This is partly how insurance companies make their money

If that isn’t the case, however, you might have to pay from your pockets.

Benefits Of Covering Your Therapy With Your Health Plan

For people diagnosed with a mental illness and are placed on prescriptions drugs, using a health plan can significantly lower the out-of-pocket costs that you might have to pay.

It is extremely beneficial to use this kind of coverage if you have an illness (es) that deeply relies on medicated treatment.

But with the limited financial power to constantly purchase prescriptions on your own.

Note, however, that while you pay out of pocket for seeing a talk therapist, some insurance companies will still cover your prescribed medications from a psychiatrist.

Do Pre-existing Conditions Impact My Coverage?

As much as health legislation is constantly changing, currently, under the Affordable Care Act, health insurance must cover even pre-existing conditions.

Insurers are by law not allowed to charge more nor deny coverage to people with mental and behavioral health issues and substance abuse disorders.

Will my therapist accept insurance?

Most people obsess about their insurance plans not covering their therapy, without even knowing that most therapists do not take insurance.

Looking for a therapist that takes insurance can really be frustrating.

And there are a couple of reasons why therapists may not take insurance

  • Because of the poor relationship between therapists and insurance companies.
  • Some therapists shy away from loads of paperwork involved with insurance that comes with no compensation.
  • While in some cases the intricate and confidential nature of therapy sessions impedes the decisions of some therapists. To either take insurance or not.
  • Some therapists feel they make less money when paid with insurance.

Due to the deficit of therapists that takes insurance, the wait time for patients can be excruciating.

Patients that want to pay his or her therapist with insurance, might have to stay for months.

This is very impractical for one who needs immediate mental health attention.

Other Reasons Why Therapists May Not Take Insurance.

The possibility of breaching doctor-patient privilege, which might cost a therapist his or her license that took lots of years and money to acquire.

In order for insurance agents to effectively discharge their duties, they might sometimes need the records of the sessions.

This happens when the insurance company feels like their client who is a patient, should have resolved his or her emotional issue within a period of time.

As we all know, insurance guys make money by not paying insurance claims or benefits. So they do all they can to make sure they do not pay.

Invading one’s privacy has never stopped them.

Some insurance companies always require that a patient be diagnosed with mental illness before they can bankroll their session.

For this reason, some therapists do not take insurance. With the hectic nature of peoples day to day life activities, a lot of people continue to seek mental health treatment.

Sometimes for reason, that is not currently defined by a specific mental health disorder.

If one’s mental health condition cannot be categorically placed under OCD or Bipolar, which are diagnosable, it is difficult to get your insurance company to cover your therapy.

Conclusion

Understanding the health plan you have activated will definitely save you from troubles and time.

For the sake of your sanity you need to find out your insurance plan, and all that it covers. If it doesn’t work for you, feel free to change.

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