Getting the Most Out of Health Insurance for Mental and Behavioral Health Care

Thrive • Dec 01, 2021

As a new year approaches, many individuals have the opportunity to participate in Open Enrollment. During this time, it can be beneficial to understand your access to mental and behavioral health care coverage so you can make informed decisions that prioritize your well-being. Whether you are unsure of what mental and behavioral benefits your current provider offers or are actively trying to obtain coverage that includes these types of care, below is some helpful information about insurance to keep in mind. 

MENTAL AND BEHAVIORAL HEALTH INSURANCE STANDARDS

Mental and behavioral health conditions can disrupt the intricate relationship between the mind, body, and spirit, resulting in significant impacts to overall well-being. So, conditions involving the mind and behavior patterns require specialized care from experts who grasp their complex nature. Fortunately, mental and behavioral health care are considered essential health benefits by the Affordable Care Act (ACA). This means that to be in accordance with the ACA, health insurance plans must cover mental and behavioral health care without spending limits. Furthermore, ACA-approved plans or “Marketplace” plans must also cover pre-existing mental and behavioral health conditions.

Marketplace plans must include coverage of:

  • Behavioral therapy: Works to change unhealthy behavior patterns.
  • Cognitive Behavioral Therapy (CBT): Teaches individuals to practice mindful awareness of unhelpful thought patterns and reframe them in a more positive way.
  • Psychotherapy: Focuses on a broad range of mental and behavioral health conditions, such as anxiety, depression, and bipolar disorder.
  • Counseling services: Targets specific struggles, such as stress management or addiction over a shorter period of time than psychotherapy.
  • Group therapy: Allows individuals to be a part of a therapeutic group of people experiencing similar obstacles guided by a mental health professional.
  • Treatments for substance use: May include sober living, outpatient, and inpatient treatment programs.
  • Prescription medications: Can be used alongside therapy to aid mental and behavioral health challenges.
  • Online tools: May include virtual care options and healthcare provider directories. 

Understanding Parity and Common Breaches

In addition to these services, Marketplace plans must treat medical and mental health benefits with parity. As such, limits on mental health coverage cannot be more restrictive than limits on medical coverage. 

Unfortunately, parity is often violated by insurance plans. Understanding common breaches can help prepare you to advocate for your mental and behavioral health treatment with your insurance provider so you can receive the care you deserve. 

 Below are just a few examples of such breaches:  

  • A plan allows fewer visits for mental health care than for other types of health care.
  • A plan’s out-of-pocket costs for mental health care are higher than for different types of health care.
  • A plan requires prior approval for mental health care but not for other types of health care.
  • A plan won’t pay for mental health treatment that your mental health provider says you need.
  • You cannot find an in-network mental health provider or schedule a timely appointment.

If you believe your plan is violating parity, you can file an insurance complaint and appeal care denials. The National Alliance on Mental Illness (NAMI) offers additional guidance for navigating health insurance and advocating for your needs.

ASK THE RIGHT QUESTIONS

If you’re uncertain about your current mental and behavioral health care benefits or shopping for new health insurance, you may want to ask the insurance provider some of the following questions: 

  • Is my mental health insurance provider different from my medical insurance provider?
  • Do my benefits include coverage of outpatient and inpatient mental and behavioral health services?
  • Do my benefits include coverage of nutrition therapy and occupational therapy?
  • Are there any limitations to my mental and behavioral health coverage? For example, some insurance plans may limit the number of visits to certain health care providers.
  • Are there any exclusions to my mental and behavioral health coverage? For example, some plans will only cover the treatment of certain diagnoses.
  • Does my insurance require a referral or preauthorization for mental and behavioral health coverage?

Asking the right questions upfront can empower you with the knowledge necessary to take control of your mental and behavioral health care. 

SUPPLEMENTARY MENTAL AND BEHAVIORAL HEALTH INSURANCE FEATURES

If you’re in the market for new health insurance, you may also consider whether certain mental and behavioral health care services are offered, such as: 

  • An emotional support line 
  • Mental health virtual care (also known as telemedicine)
  • Access to mental health services without referrals
  • Online mental health screening tools
  • A directory of in-network therapists and psychiatrists

With 52.9 million U.S adults having experienced a mental illness in 2020 , services like the ones above are becoming more commonplace, making support for mental and behavioral health concerns more well-rounded, accessible, and financially feasible.

HELP WITH HEALTH INSURANCE AT THRIVE

Health insurance can be complicated, but Thrive Wellness can help make it simpler for you. Thrive is in-network with many major health insurance providers and also has the ability to secure single case agreements. Additionally, Thrive’s business office can work with you and your insurance provider to understand your benefits and advocate for your care while doing our best to obtain coverage for your treatment. Get in touch with us to begin your mental or behavioral health healing journey.

By Sage Tippie 23 Apr, 2024
Spring Cleaning Benefits for Mental Health Spring is a time of new beginnings, change, and transitions, including in our homes. With the warmer weather kicking motivation into high gear, Spring can be a prime time to do a deep clean. Not only is a clean space aesthetically pleasing to the eyes, but it can also help to improve your mental health. Learn about how tidying up your space can also tidy up your thoughts below along with tips for cleaning when you’re struggling with your mental health. 4 Reasons Why Cleaning is Beneficial to Mental health 1.Decreased Stress Not only does an uncluttered space provide a sense of calm, but the physical act of cleaning can release feel-good endorphins, reducing feelings of stress and anxiety. As you cross tasks off your checklist, your body also releases Dopamine. Also known as the “happy hormone”, Dopamine provides a sense of accomplishment and pride that can promote motivation in other areas of our lives. 2. Improved Focus Studies have shown that an uncluttered space can also lead to an uncluttered mind. Your focus can be drawn away from important tasks by a chaotic, messy space. Research has also shown a connection between procrastination and clutter, as an unwillingness to tackle larger chores like cleaning can translate over into various areas of our lives. By keeping your space tidy, it can inspire you to stay on top of other major tasks like work and school assignments. 3. Regulated Emotions According to this 2015 study , cleaning can function as a practice in mindfulness, providing an increased sense of calm and inspiration. Slowing down while cleaning gives you room to relax and free your mind of burdens, stressors, and irritants that can affect your mental health. Cleaning can even be considered a practice of self-care as the action helps you to connect with yourself and the outcome allows you to better enjoy your own space. 4. Sense of Order and Control When experiencing mental health struggles, people may feel a lack of control over their lives and emotions. Cleaning even small areas of the home can provide an increased sense of order and control as you cross tasks off your to-do list. Through realizing your own power by simply completing minor tasks like cleaning, it can reaffirm your ability to do more. 10 Tips for Cleaning When Struggling with Mental Health Mental health struggles and disorders commonly create barriers to one’s ability to clean and properly practice personal hygiene. Although these behaviors are normal side effects of mental health disorders, we want to work to aid our clients in cleaning to the best of their ability even in difficult times. Below, Thrive Wellness occupational therapist Meadow Deason shares some helpful tips she gives to clients when they struggle with cleaning due to mental health conditions: 1.Ask For Help Having support to clean can make a huge difference. Do the cleaning with the person helping you and have them hold you accountable. 2. Don't Wait for Motivation Motivation might not come before action, but it can build as you begin to see the results of your efforts. 3. Start Small Start with one area or one task and go from there. For example, concentrate on your bedroom first and then move on to the living room and bathroom. 4. Do Something Daily Even if you do only one small cleaning task a day, doing that one task creates momentum and prevents small tasks from building up and becoming overwhelming. 5. Use Sensory Modulation Change your environment by playing music, adjusting the lighting, or using aromatherapy. This can help to put you in a new headspace for cleaning. 6. Start with "High Impact" Tasks Start with more intensive or all-over cleaning tasks such as picking up clutter or doing the dishes. The visual "noise" of some tasks makes a large impact on the entire space, building motivation to continue cleaning. 7. Make a To-Do List Write a detailed to-do list of tasks and cross them off as you go. Physically marking down what you’ve accomplished can promote increased motivation. 8. Reward Yourself Set up a reward system where you reward yourself with a favorite activity or item when you complete a task as an incentive to clean. 9. Use the Rocket Method Don't think about it, just choose a task, countdown from five or ten and then start. This can help you to avoid potential anxiety and dread that can prevent you from cleaning. 10. Gamify Tasks Make up a game for your tasks or time yourself to promote increased engagement in cleaning. Your ability to complete tasks can be affected by a multitude of different factors and conditions including OCD , anxiety, depression , ADHD , and more. If you are struggling with motivation due to your mental health, help is here at Thrive Wellness.
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