Insurers Will Now Offer Better Mental Health & Addiction Coverage

There is some great news for Americans struggling with mental health or addiction who were having problems with their insurance coverage.  Insurance plans offered in the federal and state run health insurance exchanges are required to offer coverage for mental health care and addiction treatment under the 10 essential benefit requirements.  This information comes from The New York Times article “Understanding New Rules That Widen Mental Health Coverage,” by Ann Carrns. This coverage expansion is welcome news to millions of Americans who have been suffering with seemingly no hope for help.  Whether they couldn’t find an insurance plan that offered mental health coverage or the benefits were not the same as medical coverage, they will now have help.

Inclusion in the 10 essential health benefits is not the only change affecting mental health and addiction treatment.  Back in 2008, the Mental Health Parity and Addiction Equity Act worked to make mental health coverage the same as coverage for physical health ailments.  While they have had a long road, parity rules will finally take effect in July of this year.  Most health insurance companies will have to follow these rules in their individual and family insurance plans starting next January.  When insurance companies offer mental health coverage, they will not be able to charge higher deductibles or co-pays for these visits than they do for medical visits.  They also cannot limit the number of mental health visits allowed in a more restrictive way than they do for medical visits.

Some insurance companies already follow the parity rules, but how they comply with them will now be detailed by the government.  They can’t limit the geographical region for mental health coverage if they don’t limit it for medical coverage.  Insurance companies cannot make it more difficult to get pre-approval for inpatient mental health treatments than they do for inpatient medical care.  They also have to make it clear to consumers what criteria they are using to determine their ruling.  This is good news for consumers who have been struggling to get mental health care because the insurance coverage was less adequate than their medical coverage.

It’s important to note, however, than it won’t necessarily be easier to get mental health treatment because of one big factor.  Around half of psychiatrists do not accept private health insurance as payment, mostly because their reimbursement has been terrible in the past.  Since these new rules are going in effect, it is possible that more office based psychiatrists will accept private insurance in the next few years.  Be an advocate for yourself and make sure that you know the laws and rules that apply to mental health and addiction coverage.  If you are having a hard time with your insurance company or can’t find a therapist who will accept your plan, there are free services to help you locate one.

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