By law, most commercial insurance plans must now
- offer mental health coverage, and
- provide benefits equal to what the plan offers for other medical conditions.
The financial requirements of the plan such as deductibles, co-pays and co-insurance cannot be more restrictive than for other benefits. For example, your plan cannot charge a higher co-pay or higher co-insurance percentage to see an in-network psychiatrist than it does to see any other in-network specialist. Your plan can’t have two separate deductibles—it must have one deductible for both physical conditions and mental health conditions.
The law also addresses treatment limitations on the frequency of treatment, the number of visits, duration of treatment or geographic restrictions on where you receive treatment if your plan does not have these same restrictions in place for other medical conditions.
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You can expect equal coverage when it comes to the treatment limits and payment amounts for:
- inpatient and outpatient both in-network and out-of-network,
- partial hospitalization,
- prescription medication,
- facility type,
- residential treatment,
- maximum out-of-pocket limits,
- provider reimbursement rates,
- intensive outpatient services,
- emergency care,
- co-insurance, and
- geographic locations.
Can’t Find a Prescriber?
Each person’s insurance coverage is unique, but there is one question that sums up the challenges of financial burden and timeliness of care: How difficult is it to get an appointment within a reasonable timeframe with a psychiatrist listed in your insurance network?
To better understand the patient and family experience in addressing these challenges, DBSA distributed a survey entitled “Seeking Care from ‘In-Network’ Psychiatrists”. The intent of the survey is to provide a forum for patients and their families to share their experience with insurance networks. Responses to survey questions are presented in our white paper listed below with the hope that policy-makers will understand the experience of patients and family members within insurance networks.
Insurance Network Adequacy: Psychiatrist
Is your insurance plan providing equal coverage for mental health?
Sample Letter to Insurance Plan