Health insurance plans can be difficult and stressful to deal with. But with healthcare reform and insurance practices continuing to be a recurring trend in the news cycle for multiple years now, it might pay to keep an eye on your own coverage – and figure out whether you need to take the appropriate steps to seek a different plan or amend it.
If you had a Marketplace health insurance plan in 2022, then you have until January 15, 2023 at the latest to make a change before your healthcare plan is in effect for the rest of the year. Many private health insurance companies follow similar January deadlines, which means this is as good a time as any to review your coverage and determine whether you’re safe.
It wasn’t too long ago that insurance coverage was deemed discriminatory towards consumers with mental health issues or substance use disorders.
There was a time when mental health issues were not considered as important, nor deemed as worthy of treatment as physical health issues, despite the clear correlation between the two, and the growing bodies of evidence regarding the equal importance of both mental and physical wellbeing.
Nowadays, we know better. The medical community understands and advises healthcare companies to respect that mental health issues can be debilitating, and even life threatening, and that health insurance coverage must adequately provide benefits for mental health issues that can compare meaningfully to medical and surgical care benefits.
However, we at Amend Treatment would like to warn consumers: beware! Not all healthcare plans are made equal, and we are a long way off from true parity among plans. While some health insurance plans provide ample coverage for physical and mental health issues, it’s important to be aware of your plan’s limits, and whether these are relevant to you or your loved ones.
What Do I Need to Review?
First and foremost, take your current plan’s mental health benefits into consideration. With mental health concerns continuing to rise, it may be important to note where the limits of your current policy are.
If you have a job-based health insurance plan, your employer or the responsible department will be able to provide you with a copy of your plan. Otherwise, you should be able to contact your health insurance provider and request a soft copy for immediate review.
Paperwork helps. But if you need help interpreting the policy and understanding its legal language in practical terms, don’t be afraid to call for help. You can typically request a consultation with your health insurer to clarify certain terms and ensure that you are both on the same page before you make any changes or consider a different plan before your chance to amend your policy for 2023 runs out. At Amend Treatment, we are prepared to help as well. We work with insurers to clarify terms for consumers, verify benefits, and initiate pre-authorization required for coverage.
Are You Considering Treatment?
If you or someone under your healthcare coverage is considering treatment for a major or debilitating mental health condition, then reviewing your healthcare plan this January may be vital. The right coverage can help you better shoulder the costs of mental and behavioral health care and put your mind at ease for the coming years.
We at Amend Treatment can help verify that your plan provides benefits for the type of treatment you need, and whether it includes inpatient care or an outpatient program.
Our facility specializes in helping individuals with a history of mental health issues, including conditions such as bipolar disorder, major depressive disorder, post-traumatic stress disorder, and anxiety related disorders.
In general, here are a few questions you might want to ask your insurer:
Do I Need a Referral for a Specialist?
Say you find yourself struggling with mental and physical fatigue, lethargy, low mood, and other long-term symptoms of depression during the winter months.
Some insurance companies explicitly require that a person seeks a referral to a specialist through their primary care physician, even if their concern is psychiatric.
That means you may need to see your primary care physician before going to a therapist or a psychiatrist, or even a psychiatric clinic for mental health issues, including depression, anxiety, or other illnesses.
Clarifying this with your insurer is important because they could potentially deny your insurance claim. If you want to seek treatment at Amend Treatment, we may work with your primary care provider and health insurance provider to meet the prerequisites for coverage.
Do I Need Pre-Approval?
Some health insurance plans require pre-approval or pre-authorization before you can seek medical services.
This is not the same as a referral from a doctor – whereas a referral is about your doctor’s professional opinion, a pre-approval or pre-authorization must come from your health insurer. In other words, your insurance company may be able to deny you the mental healthcare you need or deny certain claims on certain circumstances.
It is important to be specific in these cases.
If you have previously been enrolled in an outpatient or inpatient program, then you know that there are often multiple visits involved – do you need pre-authorization for each one? If you believe that residential care is the best level of care for you or your loved one, does your plan cover this level of care? Under what conditions does your insurance provide coverage? What about psychiatric hospitalization or partial hospitalization?
Sorting through these questions can be complicated, especially if you require a specific treatment plan, higher levels of care, or repeated episodes of care.
Any Other Questions?
Updating your health insurance plan or switching to a different provider can be of great benefit, especially if you are concerned about the lack of coverage for a specific condition or circumstance that applies to you or your family.
It pays to take your time and ask as many questions as you might have or reach out to us at Amend Treatment for clarification. Don’t hesitate to give us a call.