By Lisa Zamosky
Coverage for mental health and substance abuse services has been improving, thanks to several changes in federal law. While these changes are intended to help more people get access to these services, barriers remain. Here are five things to know about your rights and how to get mental health and substance abuse treatment.
1. Health reform changes the rules: The Affordable Care Act now requires health plans to include mental health and substance abuse services. The services count as one of the 10 essential health benefits that all insurers selling plans to individuals and small businesses must now provide. Insurers can no longer exclude this type of care from your policy.
2. Equal treatment is legally required: Another law that took effect in 2010 helps improve your access to needed care. It requires health plans that provide mental health and substance abuse services to offer these services on equal footing with medical health. That means your plan can’t require you to pay a $40 co-pay to see a cardiologist but $100 for a psychiatrist. Also, your plan can’t place limits on the number of inpatient hospital days allowed for mental health care when none exists for medical care.
3. Barriers still exist: Despite both laws, experts say it will take time for mental health and substance abuse coverage to gain true equality in a health care system that has largely treated them as an afterthought.
4. Check the network: It can sometimes be difficult to find mental health and substance abuse treatment providers that accept health insurance. Even when providers are listed as participating in your plan’s network, you should call their offices to confirm that they’re taking patients with your insurance.
5. Fight for your rights: You have rights when it comes to getting the care you need. You can file an appeal with your insurer if you believe the care you need was wrongly or unfairly denied. You can also appeal if you feel your health plan has made it more difficult to get mental health or substance abuse services than other types of care. Start by filing an internal appeal with your insurer. If that is denied, you can request a higher level review, which is done by an independent third party.
