Know Your Rights
In 2008, the Mental Health Parity and Addiction Equity Act (MHPAEA) law was passed, with the aim to better regulate health insurance coverage of mental health and substance use disorder needs, and with the hope of improving the chances of those with mental health and substance use disorders to receive the care they need without the detriments of higher costs and stigma. The law requires insurance providers to treat coverage for services for mental health and substance use needs in the same way they treat physical medical needs. In other words, insurance providers may not be more restrictive or apply more stringent coverage rules for mental health or substance use services. For example, this means that if most co-pays for medical or surgical office visits are not usually more than $30, then co-pays for office visits to mental health professionals should be around the same amount. This law also applies to non-financial treatment limits, meaning there cannot be annual limits to the number of mental health visits allowed in a year. What is important to remember, however, is that insurers can impose limits that regulate what is a “medical necessity” in terms of treatment coverage. Medicare.gov defines “medically necessary” as “healthcare services or supplies needed to diagnose or treat an illness, injury, condition, disease, or its symptoms and that meet accepted standards of medicine.” For example, you may be interested in your plan’s criteria for medically necessary treatment for inpatient substance use disorder in an approved facility; the criteria for this will vary based on your plan, so it is important to understand what your insurance will cover.