For many people in the United States, financial uncertainties can be an obstacle to accessing healthcare. Even if a person has insurance, it can take time to navigate their policy to determine if the care they need is covered by their plan. This concern is not limited to medical procedures. For example, does insurance cover inpatient mental health treatment? Does it cover other forms of mental healthcare? How can you find out what types of mental health services your plan will pay for?
Does Insurance Cover Inpatient Mental Health Treatment?
The answer to almost all questions about insurance coverage can be answered by the statement, “It depends on the specifics of your plan.” For now, though, let’s focus on the big picture: In the United States in general, does insurance cover inpatient mental health treatment?
The Affordable Care Act (ACA), which was signed into law by then-President Barack Obama in 2010, establishes 10 essential benefits that all health insurance plans must include. Mental health and substance abuse services are combined into one of these essential benefits. As described on HealthCare.gov, which is managed by the U.S. Centers for Medicare and Medicaid Services (CMS), this mandate means that insurance does cover inpatient mental health treatment as well as two other related types of care. All insurance plans, the CMS notes, must cover:
- Behavioral health treatment, such as psychotherapy and counseling
- Mental and behavioral health inpatient services
- Substance use disorder (commonly known as substance abuse) treatment
The U.S. Department of Health and Human Services (DHHS) also confirms that Medicare insurance covers inpatient mental health treatment.
Does Insurance Cover Other Types of Mental Health Treatment Besides Inpatient?
Inpatient treatment is the highest level of care for people who have been struggling with mental health concerns. At this level, the main goal is often to help a person achieve stabilization, so that they can return home or transfer to another program. After completing inpatient treatment, many people step down to an outpatient program for continued support.
It is also common for a person to enter treatment at the partial hospitalization or intensive outpatient levels. These programs can be ideal for people who have significant mental health needs, but whose symptoms are not severe enough to require round-the-clock inpatient care. For people in these situations, it can be extremely important to determine if insurance covers outpatient programming for mental health disorders.
Under the ACA, private insurers are required to cover psychotherapy and counseling, which are fundamental components of most outpatient mental health programs. Also, most private insurers are also subject to the requirements established in the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).
In general, the MHPAEA requires insurers to provide the same level of coverage for mental health and substance abuse treatment that they do for surgical or medical services. This includes copay limits, deductibles, number of allowable annual visits, prior authorization requirements, and proof of necessity.
For older adults and others who have publicly funded healthcare plans, Medicare Part B covers many outpatient mental health services, including evaluations, individual and group therapy, family counseling, medication management, and partial hospitalization. Medicaid also covers some mental health and addiction services, but since that program is managed at the state level, benefits may vary depending on where you live.
How Can I Tell if My Insurance Covers Mental Health Treatment in Atlanta, GA?
The limits of your insurance plan’s coverage of mental health treatment will be spelled out in your policy. Of course, it can be extremely difficult to discern exactly what is and isn’t covered by trying to read your policy. Thankfully, you have other ways of determining if your insurance covers inpatient mental health treatment as well as outpatient services. At the federal level, the websites MentalHealth.gov and CMS.gov provide a wealth of information about public and private insurance coverage for mental health treatment.
If you work for a company that has a human resources department, a member of the HR staff may be able to answer your insurance-related questions. If you belong to a union, your union representative may have the information you are seeking.
The facility where you plan to receive care should also be able to help you identify the parameters of your insurance policy. For example, when you seek treatment for yourself or a family member at Peachtree Wellness Solutions, our team will be happy to relieve you of the burden of trying to navigate the intricacies and complexities of your insurance policy.
Once you give us your permission, we can coordinate directly with your insurance provider. This includes confirming your coverage and verifying all benefits to which you or your family member are entitled. We offer this service so that you can focus your full attention on your health or the health of your loved one.
Begin Inpatient Mental Health Treatment in Atlanta, GA
Peachtree Wellness Solutions offers comprehensive mental health treatment for adults in the Atlanta, Georgia, area. Treatment options at our center include residential care, a partial hospitalization program (PHP), an intensive outpatient program (IOP), and outpatient programming. From your first call throughout your entire experience with us, you can expect to work with knowledgeable professionals who are committed to meeting your needs and exceeding your expectations. Give us a call or visit our admissions page today to learn more about how we can help.