Nearly 4 million Americans with mental illnesses don’t have health insurance that covers their needed treatments, according to a recent report from the American Mental Health Counselors Association. This is, in large part, due to the fact that nearly half the states in the nation elected not to expand coverage to include treatment for mental illness under the Affordable Care Act.
On the other hand, many non-funded state insurance programs (such as those offered to employers or the self-employed), actually are required to provide mental health care coverage. As you can see, things can be quite confusing, but there are a few questions you can ask yourself to determine whether or not you’re covered.
Did You Purchase Through the Affordable Care Act?
First of all, understand that if you purchased your health insurance under the Affordable Care Act, then you are no-doubt covered for at least a portion of your mental health care expenses. In fact, the Affordable Care Act on its own marked one of the largest expansions in mental health care coverage in United States history, according to MentalHealth.gov.
Under the Affordable Care Act, mental health care is one of 10 benefits that all insurance plans under the law are required to cover. Still, you’ll want to check with your provider specifically to find out exactly how much coverage is provided for mental health treatment and the deductibles that apply.
Do You Have Insurance Through Your Employer?
If you have a health insurance policy that’s provided through your employer, there’s also a good chance that your policy includes some type of mental health care coverage. After all, in a survey conducted in 2007 by the Society for Human Resource Management, it was found that nearly 87% of health insurance policies offered by employers in the United States include some form of mental health coverage.
Of course, not all employer-based health insurance policies are the same. This is where parity law comes in and is something you should be aware of. Under parity law, health insurance companies must treat mental illnesses in the same manner they treat any other type of medical ailment. For example, if you pay a $20 co-pay to see your regular doctor, the insurance company can’t charge you more to see a therapist or psychologist.
What about those Under Medicaid or Other State-Funded Insurance?
Sadly, if you’re currently covered a type of state-funded insurance, the chances are about 50/50 that your policy doesn’t include any coverage for mental health treatment. That’s because when the Affordable Care Act was rolled out, individual states were left to make the decision regarding whether or not they would expand coverage to include mental health. The harsh reality is that 24 of the 50 states voted not to expand their coverage.
The nation still has a ways to go when it comes to providing adequate mental health coverage for those in need. Still, those who are living with a cognitive, emotional or social disorder should pursue appropriate treatment options. The National Alliance on Mental Illness, is a great resource to raise awareness and provide education, advocacy and support group programs for those affected by mental illness.
Where does Pasadena Villa Stand in Regards to Medicaid or Other State-Funded Insurance?
State-funded insurance such as Medicare, Medicaid and SSI do not cover our services. To maintain the lowest rates for treatment with the highest quality of care, all of Pasadena Villa’s programs are primarily private payment. Many private insurance companies do not cover treatment in residential mental health programs. However, we will work with you and your insurance company on your behalf to access any possible insurance reimbursement for our services. Our Admissions Team will coordinate the verification of your benefits to see if you have mental health coverage available and if our services will be covered under your specific policy. Once it is determined that your policy will cover our services, we will coordinate the pre-certification of your benefits as well as ongoing concurrent reviews for continued coverage during the course of treatment. Our Utilization Management and Compliance Coordinator will work diligently with our clinical team to ensure all medical records clearly demonstrate medical necessity, which will significantly increase the likelihood of insurance coverage.
Pasadena Villa’s Smoky Mountain Lodge is an adult intensive psychiatric residential treatment center for clients with serious mental illnesses. We also provide other individualized therapy programs, step-down residential programs, and less intensive mental health services, such as Community Residential Homes, Supportive Housing, Day Treatment Programs and Life Skills training. Pasadena Villa’s Outpatient Center in Raleigh, North Carolina offers partial hospitalization (PHP) and an intensive outpatient program (PHP). If you or someone you know may need mental health services, please complete our contact form or call us at 407-215-2519 for more information.
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