Understanding mental or behavioral health benefits

There are many aspects of health insurance that consumers should understand, but mental or behavioral health benefits often get overlooked. If you have questions about how your plan handles issues such as depression or anxiety, you’re not alone. Fortunately, the following guide on understanding mental or behavioral health benefits will help you learn more about this topic and equip you with the information you need to make smart decisions about your care.

What are my health insurance benefits?
Most employer-sponsored plans cover some form of mental and behavioral health, whether it’s visits to a therapist or psychiatrist; substance abuse treatment; hospital stays for psychiatric care. When looking into what your plan covers, it’s important to understand that each one is unique. These plans tend to fall into two categories: mental health and behavioral health plans. Mental health plans usually include services such as individual therapy, group therapy, family therapy, intensive outpatient programs (IOP), day treatment programs (DTP), partial hospitalization programs (PHP) and inpatient psychiatric care. Behavioral health plans are often more comprehensive than mental health plans because they can include not only behavioral services but also medical services related to substance use disorders. The main difference between these two types of coverage is that behavioral health tends to be more inclusive than mental health.

How does my plan work?
Most behavioral health plans aren’t traditional HMOs. You can get some—but not all—services covered out-of-network, which means you could still use an in-network doctor for that emergency appendectomy and a psychiatrist in your network for treatment of your PTSD (post-traumatic stress disorder). Even if a behavioral health provider isn’t covered under your network, you may still be able to submit claims to your insurance company for reimbursement.

Can I make changes to my plan?
Yes. You are able to change your plan during Open Enrollment (typically October-December) or if you experience a qualifying life event such as birth of a child, marriage, divorce, and so on. For more information, check out HealthCare.gov. What is covered?: Most plans cover both inpatient and outpatient care for mental health services though they may have a variety of conditions for paying or reimbursing your treatment that are unrelated to the quality of treatment you receive.

Why did I receive a bill after visiting the doctor or hospital?
You may have received a bill after visiting your doctor’s office, hospital, pharmacy, or other medical provider because you did not have insurance that covers these services at 100%. If your insurance pays part of your medical bill, you are responsible for paying that portion of the bill yourself. Depending on your coverage, you may be able to choose from different plans to help pay for those out-of-pocket costs.

Call Us
Share This