How to Decode Your Health Insurance to Find Affordable Mental Health Care
Whether you're trying to find an in-network provider or you're struggling to find an affordable option, this guide can help you find mental health care that works for you.
If the turmoil in D.C. and staggering COVID statistics are any indications, it seems as if 2021 is ushering in the same messy reality that everyone would've loved to leave behind with 2020. This means the collective critical need for mental health services didn't go anywhere when the clock struck midnight on NYE. And while the recent increase in teletherapy options might've provided the flexibility many people need to take care of their mental health, the process of finding a therapist — not just one you like but also one you can afford — and decoding what your insurance will cover (if you're lucky to have it) is daunting.
Ironically, the process of finding a therapist is not mental health-friendly, says Kyana Brathwaite, R.N., a Philadelphia-based health care consultant who helps clients complete the complicated process. With more than 20 years of experience in the medical field, Brathwaite says she's noticed disparities in the level of knowledge people have about the U.S. health care system. "Socioeconomics doesn't really have much to do with the fact that people just don't know what to do or how to approach finding health care services," she explains. (Related: Why Is It So Hard to Make Your First Therapy Appointment?)
How you find your right treatment depends on health insurance — whether or not you have it and if so, your specific plan, according to Brathwaite. But how do you even know if your insurance covers mental health care? And, if they do, whether there are any restrictions on the number of sessions or otherwise? Ahead, learn how to determine if your insurance covers mental health care, how to find an in-network provider, and what options you have if you're uninsured.
If you're not sure if your insurance covers mental health care...
The good news is that the majority of "large group plans" (think: those provided by your employer) do provide mental health benefits, according to the American Psychological Association. And the Affordable Care Act mandates that every insurance plan offered through the Health Insurance Marketplace must include some sort of mental health coverage. Plus, the mental health parity law, which was originally passed in 2008, requires insurance companies to treat mental and behavioral health and substance use disorder coverage with equal importance to medical or surgical coverage, according to the APA. Meaning, your copay for seeing a psychologist can't be $50 when your copay for most medical office visits is only $20. But the specific costs and amount of sessions covered differ widely, and because of this, it's possible that your plan includes, say, exorbitant co-pays or a limited number of sessions.
If you have employer-provided insurance, Brathwaite recommends reaching out to your human resources department to find out about your medical health care benefits and what exactly they cover, as these specifics can vary from plan to plan. This should include information on behavioral health services and/or how many sessions for mental health and substance use disorders are covered, according to the APA. That said, you still might be responsible for part of the total cost and your co-pay. (A co-pay is the amount you're expected to pay for a given service. Depending on your plan's rules, this can be before or after you meet your deductible, the amount you have to pay for services before your insurance benefits kick in. So even if a service is covered, you may still be responsible for all or part of the payment.)
"If the person has private insurance, it is important to find out what services are covered and for how long," says Michael Considine, Psy.D., a New Jersey-based psychologist. "Then, as therapists, we try to work with our clients. For example, a high co-pay might be a barrier. So, let's say a client is authorized for eight sessions and there is a $50 co-pay [for each session]. Can the client be seen every other week instead of weekly? We would want to look at all options to make therapy affordable." (Related: Free Mental Health Services That Offer Affordable and Accessible Support)
If you're trying to find an in-network provider...
You can simply reach out to your insurance carrier to inquire about finding, say, a licensed therapist or a psychiatrist, says Brathwaite. Many insurance companies, such as Independence Blue Cross, also offer directories of in-network practitioners that patients can access online. If you have health care through the Affordable Care Act marketplace or a state-funded insurance program such as the New York State of Health, your insurer should have a similar online database.
Keep in mind that a database might not be up to date, so it's best practice to call a provider to confirm. Be patient — finding an in-network therapist may take a couple of tries, explains Brathwaite. "Providers are always coming off and on and renegotiating contracts [with insurance companies], " she notes. When this happens, someone who was once in your network might no longer be. If you find that a provider you want to use is not in-network, but you still want to move forward, it's important to ask for their NPI number, explains Brathwaite.
You'll use this number when filing a claim to your insurance carrier (something you'll commonly be asked to do when a practitioner is out of network). Your claim should also include a procedure code corresponding to a diagnosis, which your provider can give to you. This is required for insurance to partially or fully cover the cost of services. However, know that not all insurance plans include coverage for out-of-network providers and even if yours does, going out of network will still likely cost you more.
It's also worth chatting with your insurance company about getting partial reimbursement for your sessions once you've met your deductible. This is important to clarify with your insurance company ahead of time though since not all plans provide reimbursement for out-of-network services.
If you don't have insurance or can't afford care...
If you don't have health insurance or the plan you have doesn't adequately offset the cost, Brathwaite recommends looking into clinics or therapists who offer a sliding scale, which is essentially a pay structure that accommodates individuals based on their financial means (i.e. income). Sites such as Psychology Today provide directories for therapists that can be sorted by location, specialties, background, and whether or not they offer sliding scale rates. Other organizations, such as Inclusive Therapists, Therapy for Black Girls, and the APA, offer easily-accessible directories with similar features on their websites.
If you're willing to be seen by "a student intern" — someone being trained at the master's or doctorate level — you might be able to be seen sooner than waiting for your top-choice doc's schedule to clear, adds Considine. Plus, sessions with interns are often free of charge, according to Psychology Today. You can find an intern by contacting schools with master's-level programs and asking about any low-cost opportunities like such.
In many states, you can also dial 211 for information on free or low-cost mental health resources in your area. (You can find out if your state has a 211 program or similar here.) The National Alliance on Mental Health is another valuable tool with a host of resources that includes support group information and a helpline. (Related: How to Go to Therapy When You're Broke AF)
Unfortunately, there's no denying that the process of finding mental health services with — or without — insurance can be tough. But the reward of bettering your mental health — and, ultimately, feeling better — is worth it.