Mental Health Insurance Benefits: A Brief Overview

Policyholders need to review their mental health insurance benefits to avoid this troubling question.

Our team at SoCal Empowered recently shared the exciting news that we are now an in-network provider for Anthem Insurance, which opens the door to extremely efficient mental health insurance benefits clarifications and coverage for those who hold one of these health insurance policies. However, this move forward has also alerted us to quite a few questions with regards to how all of this works. That’s likely because of the many mental health myths that still exist.

Taking advantage of mental health insurance benefits is something that everyone who is struggling should do, but unfortunately not enough people take this step when necessary. There are a lot of reasons for this, and as we discussed here, nearly 25 percent of people who do not make use of mental health insurance benefits refrain from doing so because they do not realize that those benefits exist.

We cannot ask that anyone out there with these problems take advantage of their mental health insurance investment more strongly than we have, but in the meantime, we’re going to explain below what it means to have a team like SoCal Empowered empaneled as an in-network mental health provider. As you’ll see, it makes things much easier for you and your loved ones as it relates to your coverage when the time comes to seek help.

Medical Organizations and Insurance Companies Are Private Entities

We’re not going to delve too deeply into the minutiae of the American healthcare system, but it’s safe to say that most people understand that every medical organization and insurance company is its own private entity. That includes:

  • Hospitals
  • Clinics
  • Inpatient mental health facilities
  • Health insurance carriers
  • Pharmacies

There are others, but every one of these places you go to for help is either its own business entity in the eyes of the law and the state or part of a much larger organization or even conglomerate. Of course, there are exceptions such as state-run hospitals and clinics or other non-profit entities, but for the most part our healthcare system needs are fulfilled by different entities of different sizes.

Healthcare Costs Can Vary Widely

Given that each of these medical organizations is its own entity, then it should also seem quite logical that the pricing for all of the supplies and services are in some degree independently derived based on what the market will bear. When you go to the hospital, the cost of every surgery, bed, bandage and meal is determined by the health entity based on several different factors. That’s why one hospital stay at one location can be thousands of dollars more expensive than the same stay somewhere else.

Generally, the costs of the supplies and many services provided to patients are negotiated between the medical organization and the supplier, such as a medical supply wholesaler or even a health organization to which specialists such as radiologists belong. These costs are then passed on to the patient, either directly or indirectly through that patient’s health insurance coverage. After the insurance company determines coverage, the patient is responsible for whatever cost remains.

How Networks Add Efficiency To This Process

One of the ways in which people with health insurance benefit is by way of groups of providers being “in-network” with their insurance company. What does that mean? It means that for the most part, doctors and other medical care providers who are in-network have already negotiated certain pricing structures for their services with insurance carriers.

That means that when you go to see a doctor because you’re sick, and he or she is in your insurance company’s network, you’ll know immediately how much of the fees are covered by insurance and what you’ll be responsible for when the care is complete. It provides a level of certainty with regards to cost and it makes the entire intake process and claim processing efforts much more efficient.

Challenges With Out-of-Network Providers

When someone falls ill and he or she obtains services from a medical provider who is not in his or her health insurance company’s network, the entire process can be much more difficult. First, the pricing for an out-of-network provider is not pre-set with the insurance company, which means that the patient will not really understand the potential costs involved with receiving treatment.

Secondly, the claims process can be difficult for several reasons, not the least of which is that payment from any source can take time given that the pricing and payment amounts need to be negotiated for each claim. None of this even gets into the potential issues that exist with regards to PPO vs. HMO insurance, as that difference can also be important when dealing with out-of-network providers.

Mental Health Insurance Benefits and In-Network Providers

Finally, with regards to mental health insurance benefits, the potential confusion discussed above as well as the troubling statistic relating to how many people are not aware of the fact that they even have mental health insurance benefits means that far too many people are not getting the help that they need and deserve.

Now that SoCal Empowered is an in-network provider for those who have mental health insurance benefits with Anthem Insurance, those who need inpatient mental health care can simply contact us to find out how our intake process works, how we help the people we work with, the types of conditions we treat and anything else that they want clarified.

What those in this position will NOT have to do is wonder how all of this is going to be handled by their insurance company. We will do that for you. With your permission, we will reach out directly to your insurance company to clarify your mental health insurance benefits. If you carry Anthem insurance, that process will not take long.

What’s most important is that regardless of the identity of your insurance company, contact us for the mental health help you or a loved one may need. We’ll listen to your situation and do the rest, whether it’s helping you come to stay with us or finding you the best option for a solution to your situation. We look forward to hearing from you soon.