Understanding Mental Health Plans

Mental Health

One’s state of mental health can be very complex, and finding the correct mental health services - and coverage – for a mental condition can sometimes be just as complicated. To simplify things, we’ve prepared a general overview of today’s mental health insurance, what services are typically covered and a few other, pertinent points.

What are mental health conditions typically covered by health plans?

As always, a health plan pays for only those services specifically called out in the plan's list of covered services. For mental health services, a variety of inpatient and outpatient treatment are frequently covered by even the most general of health plans. However, there is a range of services between inpatient and outpatient care that effectively treat numerous mental disorders and are often more economical, from a cost perspective, than inpatient care. These services include non-hospital residential services, partial hospitalization services, and outpatient services such as mental health case management. Another option - psychosocial rehabilitation - includes pharmacologic treatment, social skills training, and vocational rehabilitation. These types of services are covered by about half of employer-sponsored health plans in the United States. It’s important to check your own plan for more details.

Who do I contact first about a mental health condition?

A primary care physician is often the initial contact for health care. These types of physicians include family practitioners, general practitioners, and pediatricians. A primary care physician is allowed to prescribe medications and usually treats most general medical disorders. He or she will also refer patients to a mental health services specialist when required.

Many people seek alternative treatments for mental health conditions. An alternative medicine physician is one who specializes in complementary and alternative medicines, along with holistic medicine, nutritional medicine, and herbal medicinal treatments. These types of doctors have the ability to prescribe regular medications but often choose diverse approaches that can mingle natural medicines with mental health therapies. Once a physician determines the appropriate wellness plan and possible treatment, they then may refer a patient to a mental health therapist such as a psychologist, a psychoanalyst, or even a life coach.

Meet the experts:

Psychologist: Mental health services are often dispensed by a trained psychologist - someone qualified to provide professional counseling on psychological and emotional matters. Psychologists often specialize in a variety of areas, such as marital counseling, relaxation therapy, stress management, or even sex therapy. A psychologist, however, does not have the ability to prescribe medications.

Psychoanalyst: Psychoanalysts follow Sigmund Freud's theories about the belief that painful childhood memories contained in the subconscious are the cause of emotional turbulence. Psychoanalysts are similar to psychologists in that they usually deal with the emotional side of things but do not prescribe medication in the delivery of mental health services. Their approach is also different from conventional psychologists. Psychoanalysis can be described as a method of “searching through a person's subconscious memories for the source of their current difficulties”, rather than simply focusing on conscious memories. Psychoanalysts also tend to meet more frequently with their clients, preferring to meet as often as three to five times in a given week.

Psychiatrist: A psychiatrist is a doctor who specializes in treating mental, emotional, or behavioral problems. This type of physician can prescribe medications and can also establish therapy sessions to treat his or her patient. Psychiatrists are often more expensive that psychologists – something that its important to know if your health plan has an annual mental health services dollar cap.

What’s the insurance climate right now with regard to mental health?

Currently, insurance companies are somewhat guarded towards mental health services claims due to the drastic increase in the number of fraudulent claims. When Medicare performed an investigation into fraud in community mental health centers last year, it resulted in the barring of participation of 80 centers in nine states. The Health Care Financing Administration (HCFA), which administers Medicare, initially noticed the average yearly cost for each senior getting mental health services jumped from $1,642 in 1993 to more than $10,000 by 1997, causing considerable

Additional Resources.

There are many online resources that can be used for information gathering on various mental help challenges. USA.gov is the U.S. Government’s official Web site and has many useful offerings. A straightforward search on Google for the term “mental health resources” yields 117,000,000 results alone. These online resources can provide guidance towards local agencies that can be used to find more mental health services in your immediate area.

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