Mental Health and Insurance

Right now could you get seen by a mental health professional? If you were having a mental health crisis or thoughts of harming your self or others do you think that your insurance plan would allow you to go see a doctor within the next 24 to 72 hour period? Do you think that your health insurance would be covering it hundred percent? Would you have a deductible or co-pay? How much would that be? How many visits would you get covered? And would your insurance stopped covering after a certain number of visits?

I am starting to read up on this because I would like to understand more about how our health insurance systems work when it comes to mental health. I know that a family member was only able to get six visits covered for a pretty severe anxiety issue. And it was not cheap. And I am wondering how the standard plan would work? Now imagine you are having a mental health crisis. And then imagine you have to try to figure out if your insurance will cover going to a doctor. You may not have a choice and your insurance provider because it is provided through your employer. The whole system is very complicated and may not be easy to navigate i’m in the middle of a breakdown or psychotic rage or whatever.

And should be looking at how we handle these problems in what we do for people who are experiencing trouble.

blackjack50 said:

Right now could you get seen by a mental health professional? If you were having a mental health crisis or thoughts of harming your self or others do you think that your insurance plan would allow you to go see a doctor within the next 24 to 72 hour period? Do you think that your health insurance would be covering it hundred percent? Would you have a deductible or co-pay? How much would that be? How many visits would you get covered? And would your insurance stopped covering after a certain number of visits?

I am starting to read up on this because I would like to understand more about how our health insurance systems work when it comes to mental health. I know that a family member was only able to get six visits covered for a pretty severe anxiety issue. And it was not cheap. And I am wondering how the standard plan would work? Now imagine you are having a mental health crisis. And then imagine you have to try to figure out if your insurance will cover going to a doctor. You may not have a choice and your insurance provider because it is provided through your employer. The whole system is very complicated and may not be easy to navigate i’m in the middle of a breakdown or psychotic rage or whatever.

And should be looking at how we handle these problems in what we do for people who are experiencing trouble.

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For starts, I don't have an answer, living up here, but wanted to give you props for asking the right questions. Up here we start with 15 counselling sessions being covered, with more available if required. To get this for free, you need to be referred by your doctor.

Given the cost of mental health issues, you would think this would be a good investment by your government for your citizens.

blackjack50 said:

Right now could you get seen by a mental health professional? If you were having a mental health crisis or thoughts of harming your self or others do you think that your insurance plan would allow you to go see a doctor within the next 24 to 72 hour period? Do you think that your health insurance would be covering it hundred percent? Would you have a deductible or co-pay? How much would that be? How many visits would you get covered? And would your insurance stopped covering after a certain number of visits?

I am starting to read up on this because I would like to understand more about how our health insurance systems work when it comes to mental health. I know that a family member was only able to get six visits covered for a pretty severe anxiety issue. And it was not cheap. And I am wondering how the standard plan would work? Now imagine you are having a mental health crisis. And then imagine you have to try to figure out if your insurance will cover going to a doctor. You may not have a choice and your insurance provider because it is provided through your employer. The whole system is very complicated and may not be easy to navigate i’m in the middle of a breakdown or psychotic rage or whatever.

And should be looking at how we handle these problems in what we do for people who are experiencing trouble.

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My health insurance covers mental health professional visits and hospitalization if necessary. I believe I do have a copay, not sure.

Edit: I also think there is a limit on the days you can spend at a facility. Again, I'd have to look it up to be sure, but Nate's post made me think of it

The biggest problem I've found, having a loved one who is mentally ill, is getting a grown adult who is a danger to himself or others, committed against his will...it practically take an act of congress...

Elvira said:

The biggest problem I've found, having a loved one who is mentally ill, is getting a grown adult who is a danger to himself or others, committed against his will...it practically take an act of congress...

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Yep. And that is a 2 way street. It is wonderful if you can get it. But also scary because you could have some real scum out there using it to abuse rights.

blackjack50 said:

Right now could you get seen by a mental health professional? If you were having a mental health crisis or thoughts of harming your self or others do you think that your insurance plan would allow you to go see a doctor within the next 24 to 72 hour period? Do you think that your health insurance would be covering it hundred percent? Would you have a deductible or co-pay? How much would that be? How many visits would you get covered? And would your insurance stopped covering after a certain number of visits?

I am starting to read up on this because I would like to understand more about how our health insurance systems work when it comes to mental health. I know that a family member was only able to get six visits covered for a pretty severe anxiety issue. And it was not cheap. And I am wondering how the standard plan would work? Now imagine you are having a mental health crisis. And then imagine you have to try to figure out if your insurance will cover going to a doctor. You may not have a choice and your insurance provider because it is provided through your employer. The whole system is very complicated and may not be easy to navigate i’m in the middle of a breakdown or psychotic rage or whatever.

And should be looking at how we handle these problems in what we do for people who are experiencing trouble.

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I just ran a couple I care for through inpatient psych evals and it was completely covered. In their case it was covered by Tricare (retired military) and Medicare. Other marketplace plans may not offer the same coverage.

Lutherf said:

I just ran a couple I care for through inpatient psych evals and it was completely covered. In their case it was covered by Tricare (retired military) and Medicare. Other marketplace plans may not offer the same coverage.

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Would you describe the process as easy? Or painful? Time consuming? How about for someone having an issue?

Insurance covers it but it is problematic. First, yeah, it can take forever to get an appointment. And when you finally get in you won’t be seeing a specialist. Also, for it to be covered it must be medically necessary, which means it requires a diagnosis. Not everyone who needs to see a therapist has an actual mental illness.

Another thing to keep in mind is when dealing with insurance companies confidentiality becomes problematic. Dealing with insurance companies can also be stressful in itself and is just another stressor that someone in a fragile mental state may or may not be able to cope with.

Elvira said:

The biggest problem I've found, having a loved one who is mentally ill, is getting a grown adult who is a danger to himself or others, committed against his will...it practically take an act of congress...

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Yep. It's VERY important that if you get a medical POA for someone you're taking care of that you also get a Mental Health POA. Different states have different rules so make sure to check your situation.

blackjack50 said:

Right now could you get seen by a mental health professional? If you were having a mental health crisis or thoughts of harming your self or others do you think that your insurance plan would allow you to go see a doctor within the next 24 to 72 hour period?

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Virtually anyone can do this. If you're having a crisis and/or thoughts of harming yourself or others, you just go in. You don't even think about health insurance. It doesn't matter. You go in.

Do you think that your health insurance would be covering it hundred percent?

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Probably not, but if it's a crisis, and/or there's risk of serious harm, that doesn't matter.

Would you have a deductible or co-pay?

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Probably, but if it's a crisis, and/or there's risk of serious harm, who cares?

How much would that be? How many visits would you get covered?

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My plan is $35 copay, unlimited visits.

And would your insurance stopped covering after a certain number of visits?

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Mine doesn't, but if it's a crisis, and/or there's risk of serious harm, who cares?

I know that a family member was only able to get six visits covered for a pretty severe anxiety issue.

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Covered 100%? Then what? Subject to deductible and then covered 100%? Mental health providers can appeal to insurance companies to provide for more visits. These might be called "prior authorizations." Just requires some documentation that the person really definitely needs the services.

And it was not cheap.

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That's okay. It's just money. Mental health and getting through a crisis is more important than the cost of needed, effective care. Mental health providers, especially those that provide therapy, have to cover the costs of rent, internet, phone, continuing education, licensure renewals, electronic health records systems, supervision and consultation of cases, W2 employee wages and benefits (if they're an agency), and numerous other things. Therapy providers are not getting wildly rich. It sounds like a lot of money, but compared to serious harm and actual mental health crisis? Who cares that it costs some money and isn't free? Just get it. When you need transportation, do you wring your hands about the cost of buying a used car? No, it costs what it costs, you need it, you find the money and buy it.

There are many private practice therapists that only accept cash and will not bill insurance on patients' behalf. Does this sound catered to the rich? Probably does, to a lot of people. But guess what? Not-rich people show up ready to pay the money. Why? Because 1) they need the help, 2) the help is effective (evidence-based), 3) no insurance reimbursement offers total privacy, and there are probably other reasons.

Now imagine you are having a mental health crisis. And then imagine you have to try to figure out if your insurance will cover going to a doctor.

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Again, you don't have to figure out anything in advance of getting help. What you do is you go get the help.

Skeptic Bob said:

Insurance covers it but it is problematic. First, yeah, it can take forever to get an appointment. And when you finally get in you won’t be seeing a specialist. Also, for it to be covered it must be medically necessary, which means it requires a diagnosis. Not everyone who needs to see a therapist has an actual mental illness.

Another thing to keep in mind is when dealing with insurance companies confidentiality becomes problematic. Dealing with insurance companies can also be stressful in itself and is just another stressor that someone in a fragile mental state may or may not be able to cope with.

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Very good points. And one of the primary factors I think...for when people ultimately go and then stop getting treatment. It isn’t like going to see your GP for an anual check up.

blackjack50 said:

Very good points. And one of the primary factors I think...for when people ultimately go and then stop getting treatment. It isn’t like going to see your GP for an anual check up.

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And there is an issue here as well.

Some insurance companies use mental health diagnosis to refuse treatment for other medical conditions.

For example, I had a patient that had sciatic pain for years going down her leg. It matched up perfectly with her MRI showing a herniated disk displacing her s1 nerve root. Clear as a bell. Had failed conservative treatment (and the insurance company required multiple tries at conservative treatment).

when we tried to get authorization for surgery... they required a psychiatric evaluation. But here is the kicker... they required a psychiatric evaluation... BUT.. unless she came up with a psychiatric diagnosis... then they would NOT PAY for the psychiatric evaluation.

So if would cost her 550 dollars out of pocket.

However, IF they found a psychiatric diagnosis (some situational depression would not have surprised me given her dysfunction for over a year).. then she would not qualify for surgery!.


Luckily she passed the psych exam and she was able to pay out of pocket for the exam... and eventually had surgery.

but even the insurance companies use mental health as a weapon against people.

blackjack50 said:

Right now could you get seen by a mental health professional? If you were having a mental health crisis or thoughts of harming your self or others do you think that your insurance plan would allow you to go see a doctor within the next 24 to 72 hour period? Do you think that your health insurance would be covering it hundred percent? Would you have a deductible or co-pay? How much would that be? How many visits would you get covered? And would your insurance stopped covering after a certain number of visits?

I am starting to read up on this because I would like to understand more about how our health insurance systems work when it comes to mental health. I know that a family member was only able to get six visits covered for a pretty severe anxiety issue. And it was not cheap. And I am wondering how the standard plan would work? Now imagine you are having a mental health crisis. And then imagine you have to try to figure out if your insurance will cover going to a doctor. You may not have a choice and your insurance provider because it is provided through your employer. The whole system is very complicated and may not be easy to navigate i’m in the middle of a breakdown or psychotic rage or whatever.

And should be looking at how we handle these problems in what we do for people who are experiencing trouble.

Click to expand...

Some jobs offer an employee assistance program that is free or very low-cost, and includes mental health professionals that you can see. A lot of ppl are loathe to take advantage though for fear that their job will find out. Plus the whole mental illness stigma. We just got on the ACA, our COBRA (through retired husband's employer) having just expired. I honestly don't know if we have coverage for that or not. We do have a $6K/per person deductible though.

Elvira said:

The biggest problem I've found, having a loved one who is mentally ill, is getting a grown adult who is a danger to himself or others, committed against his will...it practically take an act of congress...

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The ACLU pretty much ended involuntary commitment except after the fact. Now that mental health money (at least in California) has been sucked up by other bureaucracies, or devalued by inflation.