Mental Health Insurance Coverage – You Have Rights and Options

Mental health insurance coverage is part of most health plans.

The term, “mental health insurance coverage” may cause people’s eyes to glaze over, but it really shouldn’t. We recently delved into some extremely troubling numbers relating to mental health in the United States. Those statistics revealed that of the nearly 50 million people who suffer from some sort of mental health challenge, more than half of them have not sought out treatment. Those numbers trace to before the COVID-19 pandemic, which means that it’s likely that both data points have gotten worse over the past couple of years.

Given that unfortunate reality, our work as an Orange County mental health resource naturally leads to finding out more about why people are not seeking the help that they need. According to a study – once again, from before the pandemic – published by the American Psychological Association, the following were the 10 most-cited reasons people did not seek mental health help listed along with the percentages of people responding with those reasons:

  • Affordability – 39 percent
  • Thought they could handle the problem themselves – 26 percent
  • Did not know where to go for services – 24 percent
  • Did not have time – 20 percent
  • Health insurance does not cover enough – 16 percent
  • Concerns about being committed/taking medication – 12 percent
  • Treatment would not help – 11 percent
  • Social/societal stigma – 10 percent
  • Confidentiality concerns – 9 percent
  • No health insurance coverage – 8 percent

Each of the bolded items above either relates directly or indirectly to one of the biggest problems with regards to this public health challenge: uncertainty with regards to mental health insurance coverage. We’d like to lay some basics out for you so that you can get the mental health insurance coverage you and your loved ones need so that if that need arises, you won’t have to suffer needlessly without taking advantage of resources at your disposal.

Mental Health Insurance Coverage Is Required

One of the main problems that exists when it comes to mental health insurance coverage is that policyholders really don’t ask much about it when they purchase health insurance. It’s only natural for people to worry about other forms of illness such as cancer or pneumonia or injuries such as broken bones or concussions.

That may be natural, but it’s still regrettable. That’s because a lot of people may be unaware that in most cases, providers are required by law to offer mental health insurance coverage. For instance, according to the federal government:

As of 2014, most individual and small group health insurance plans, including plans sold on the Marketplace are required to cover mental health and substance use disorder services. Medicaid Alternative Benefit Plans also must cover mental health and substance use disorder services. These plans must have coverage of essential health benefits, which include 10 categories of benefits as defined under the health care law. 

One of those 10 categories is mental health. In addition, mental health insurance coverage offered on the marketplace is required to comply with what are known as parity requirements. The term “parity requirements” essentially means that health plans must offer mental health coverage that’s not any more restrictive in terms of its coverage benefits than what is offered for medical or surgical purposes.

These parity requirements date back to 2008, when congress passed what is known as the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008. This is commonly referred to as the MHPAEA, and that could prove to be important to know if you decide to check into your own mental health insurance coverage.

Don’t Be Afraid to Ask

The absolute worst time to contact your health insurance provider to find out more about your specific benefits is when you urgently need them. At that point, if you’re sick or you’ve been injured, there really is no time to discuss possibilities for the most part and you as a policyholder will never have less leverage, as you need that surgery or that medication urgently.

It’s generally an even worse situation for those who encounter mental health challenges. People suffering in this regard – as noted in the study quoted above – are already hesitant to discuss the matter with anyone for several reasons. Not to mention, too many people are unaware of the mental health insurance coverage they already have, and if they find out that it’s not enough coverage, they tend to simply let things go.

Physically, it’s “easier” to let something like depression or anxiety linger than it is a broken leg, but that doesn’t mean that it’s any less dangerous. Therefore, you should contact your insurance provider as soon as possible to find out what the tenets of your mental health insurance coverage are, and if they’re not satisfactory, adjust them so that you’re protected. After all, you are the policyholder and this is your right. Otherwise you or someone you love could risk becoming one of the tens of millions of people in the United States who suffer silently with no help in the offing.

SoCal Empowered Can Do the Asking For You

As we also discussed recently, serving as a true Orange County mental health resource means that our team at SoCal Empowered feels that cost should not be a barrier to critical mental health treatment. We also understand that for many reasons, it can be intimidating to talk to your insurance provider, as no one looks forward to trying to analyze fine print or deciphering coverage benefits in the abstract sense.

We want to eliminate this as a reason that people do not get the help that they need. Therefore, people who contact us wondering if what we provide would help them can rest assured that if they’re not certain when it comes to their mental health insurance coverage, we can provide that certainty. If we discuss your situation and decide that you or a loved one should come and stay with us for treatment, we’ll talk to your insurance company directly so you don’t have to. That will help you understand what’s in front of you that much better.

Please feel free to contact us if you need help with your mental health or with the mental health of a loved one. We’re here and ready to listen. Get started today so you can recapture the mental health and happiness you deserve.