If you have health coverage through an employer-insured health plan:
Individuals who have coverage through an employer should check the Summary of Benefits and Coverage (SBC), a description of your company’s health benefits package. This should include information on what kinds of services are covered, including mental health and behavioral services. Employers often pay some or all of the monthly premiums, but it is important to understand what expenses you will be responsible for across all your healthcare needs. As a reminder, the Mental Health Parity Law does not require that all employer-sponsored health plans must include mental health coverage; rather, the law ensures that if your plan does include mental health services, that its costs not be more stringent than other medical costs. For employers that offer several options for healthcare plans, it is important to review each one and understand the mental health services offered, if they are included. If you were already seeing a healthcare provider for mental health services prior to your employer-sponsored coverage, it is equally important to check if those providers, as well as the medications you may be taking, are then included in the network of providers and covered treatments under the available health plans. Often, the types of mental health services that are typically covered by employer-based health plans are emergency care, outpatient mental health treatment, inpatient hospitalization, partial hospitalization, and prescription drugs.
Another section to look out for in your health plan is the criteria for “medically necessary treatment,” which will vary between plans, and the criteria for what your insurer deems as medically necessary will also vary. You can always request these documents for the kind of treatment you are interested in, mental health-related or otherwise. This is especially important since you may be able to apply for an exception or appeal a typically non-covered service or treatment, if you find that it meets your insurers “medically necessary” criteria. Reviewing this criteria will help you determine what kind of treatment options you have and the costs related to them, and help avoid unforeseen medical bills. TCHS recently penned a helpful article on managing medical debt, which can be found here.
It is also a good idea to look into any workplace wellness programs or services your employer may offer, in addition to your employer-based health coverage. Our 2018 Consumer Survey found that of the 58 percent of respondents who reported that their employer offered managed programs for substance abuse or mental health, only 22 percent were enrolled in these programs. To get the most out of your employee resources and better understand your benefits, you can also contact your benefits office or human resources department at your employer. If you still have questions about whether your plan covers mental health services (or if you have been denied coverage, reached a limit on your plan, or an overly large copay or deductible), you can visit the Mental Health and Addiction Insurance Help Portal from the HHS website.