Private Insurance Policies on Mental Health Coverage

Tamsen Butler
Mental Processes

Private insurance policies on mental health coverage vary greatly depending on the coverage and the private insurance company. While some policyholders may find that mental health services are fully covered under their insurance policy, others may struggle to obtain permission from their insurance company to seek out even the most basic mental health services.

Mental Health Services

Insurance companies agree to pay a certain percentage of healthcare services as predetermined in the original coverage agreement. Mental health services do fall under the umbrella of health care, although there are some insurance companies that are reluctant to provide coverage for mental health ailments or the medications and treatments that can accompany mental health disorders.

There is much more to mental health services than occasional visits to a psychotherapist to talk about feelings. Anything that falls under the classification of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) can be considered a mental health issue by a private insurance company. Disorders included within the DSM-IV-TR include Autism, eating disorders, and sleeping disorders. Mental health services can become quite costly, particularly for those patients with serious psychopathologies.

Treatments

Psychotherapy can be expensive, which is why most private insurance companies place restrictions on how many sessions are allowable. Oftentimes a grouping of sessions will be allowed on a "per instance" basis, meaning that policyholders may be allowed a certain number of sessions for one mental health issue and then another group of sessions for a separate mental health issue. Patients who need more than the allotted number of therapy sessions will traditionally have to visit their primary physician in order to obtain a referral for additional sessions, but this does not guarantee that the insurance company will approve the additional sessions. There are also some private insurance company policies that do not provide any coverage for psychotherapy whatsoever.

Medications are prescribed in some cases when a patient has mental health problems. For example, this may include antidepressants, anti-anxiety medications, or anti-psychotic drugs to control hallucinations and other psychotic behaviors. These medications can be quite expensive and it is not uncommon for some mental health patients to need more than one type of medication. Private insurance policies on mental health coverage may cover the cost of these medications or they may only pay partially for the medications. People with certain types of health insurance coverage may find that these medications are not covered at all so they must pay for them out of pocket.

Assisted care and hospitalization may be necessary in acute and serious instances of mental health problems, but whether the high expenses associated with these events are covered by private insurance companies depends on the policy. Patients needing extensive hospitalization and treatment for mental health issues may quickly find their insurance benefits exhausted.

Private Insurance Policies on Mental Health Coverage Justification

Mental health problems can seem like an intangible issue to some people and this may be part of the reason why private insurance companies are reluctant to offer ample coverage for these issues. Unlike physical problems where a definitive diagnosis is possible, mental health issues can be difficult to diagnose and may not be easily treatable.

Some private insurance companies may make the assumption that a person with serious mental problems may be better served by health coverage offered by government programs such as Medicare or a state-run health coverage program.

For patients dealing with mental health issues, however, a lack of adequate coverage can prove to be extremely problematic. Psychopathologies--particularly serious disorders--left unchecked can be disastrous.

Patient Coverage

Find out if your insurance policy covers mental health treatment and medications by checking the details of your policy or by speaking to your insurance representative. If your private insurer will not pay for the mental health treatment you need, file an appeal or get help from a health coverage assistance program within your state.

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Private Insurance Policies on Mental Health Coverage