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

Thrive • December 1, 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.

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By Erin McGinty Fort, MS, MHA, CPC, LPC-S, CEDS-C December 18, 2025
Sometimes, people need more support, structure, and monitoring than the typical outpatient setting can provide. When this happens, the treatment team will usually recommend that someone be "stepped up" to a different level of care, or program, that can better meet their needs. I like to think of it as being similar to medication dosages; people need different strengths of medications, or dosages, to get better when they're sick. Stepping someone up to a higher level of care is like increasing the dosage of a medication to match the severity of their symptoms. How Are Higher Levels of Care Different from Standard Outpatient Care? At the core of differentiating higher levels of care from standard outpatient care is the intensity and structure of the treatment. Higher level of care programs tend to offer more days of treatment each week and more hours of treatment per day than in the outpatient setting. Those in higher level of care programs may also meet with their treatment team members more frequently each week. There are more staff present to support someone at or after meals and snacks, or to help those who are having urges to engage in compulsions or other harmful behaviors. Clients in our HLOC programs get access to an assortment of treatment modalities tailored to their individual needs, including personalized therapy sessions, group support, medication management, medical nutrition therapy with a dietitian, and check-ins with our primary care providers. We support clients with personalized treatment plans and regular assessments to monitor and tweak interventions as needed. Higher levels of care also offer increased peer interaction and support. Intensive programs incorporate additional group therapy sessions, which can help those in treatment feel less alone as well as create a greater sense of community. For some people, it can be difficult to devote the time and energy needed to recover while also balancing other responsibilities like school or work. Stepping up to more intensive levels of care allows people to fully dedicate themselves to recovery. As they get better and make progress, a person may be stepped back down to a less intensive level of care to start practicing their recovery in their usual home, school, or work settings while also receiving professional support from their treatment team. What Levels of Care are Available? At Thrive Wellness, we offer four different levels of care to help clients step up (or down) in their treatment when needed: -  Outpatient Treatment - weekly, bi-weekly, or monthly meetings with a therapist, psychiatrist, primary care provider, and/or dietitian. - Intensive Outpatient Program (IOP) - A minimum of three hours per day, three days per week. - Partial Hospitalization Program (PHP) - A minimum of six hours per day, five days per week. - Residential Treatment - Coming soon in 2026, The Greenhouse at Thrive will offer residential treatment for eating disorders, anxiety disorders, and obsessive-compulsive disorder. This level of care offers 24-hour support for those aged 12-24 living in our residential treatment center. How To Decide Which Level of Care is Right for You If you're unsure which option is right for you or your loved one, we offer a free assessment that can be completed with our admissions team. In this initial assessment, we'll gather information from you about what you're struggling with, speak with our team of providers, and then make a recommendation for what level of care we feel is the best fit for you and your needs. If you’re experiencing symptoms of an eating disorder, anxiety disorder, or other behavioral or mental health challenges, don’t hesitate to reach out. To get started with our intake process, give us a call at 775-525-8103 or fill out this form . We can’t wait to help you Thrive.
December 2, 2025
Like the fir tree, a symbol of endurance rooted in hope, our Family Inclusive Recovery (FIR) approach reflects the strength that grows when families face challenges together. At our new residential center “The Greenhouse”, FIR is more than a treatment model, it’s a philosophy of healing that places families at the heart of recovery for adolescents and young adults navigating eating disorders, anxiety disorders, and obsessive-compulsive disorder (OCD). We believe lasting healing doesn’t happen in isolation; it’s built with the support of families through perseverance, hope, and compassionate care. What Is Family Inclusive Recovery (FIR)? Family Intensive Recovery (FIR) is a specialized and immersive approach that actively engages caregivers as central agents in their child’s healing process. Rather than seeing families as contributors to a problem, we view them as essential partners in recovery. Drawing from two evidence-based frameworks, Supportive Parenting for Anxious Childhood Emotions (SPACE) and Family-Based Treatment (FBT), FIR helps families cultivate resilience, confidence, and connection throughout the journey to recovery. Grounded in SPACE and FBT Through the SPACE model, parents learn how to recognize and reduce well-intentioned but unhelpful behaviors known as accommodations that can reinforce anxiety and OCD symptoms. By shifting from rescuing to supporting and challenging, parents develop the confidence to guide their child through discomfort, helping them build distress tolerance and self-trust. Simultaneously, Family-Based Treatment (FBT) empowers families to take an active, compassionate role in their child’s nutritional and emotional recovery. Parents learn how to support weight and nutritional restoration, disrupt the eating disorder’s patterns, and reestablish boundaries that promote health and growing autonomy. Together, these approaches strengthen both the individual and family system, allowing recovery to take root within an environment of empathy and optimism. From Blame to Collaboration A cornerstone of the FIR model is removing blame. At Thrive, parents are not viewed as the cause of their child’s struggles, but rather as key partners in recovery. Treatment focuses on joining forces to create a safe, supportive environment where: Families learn to sit with their child's discomfort alongside them without rushing to fix or control it. Parents practice compassionate firmness, setting boundaries grounded in care and safety. Teens and caregivers rebuild trust through open, honest communication. This collaborative framework helps families reestablish a sense of connection and confidence, fostering long-term resilience and open communication that extends beyond the treatment setting. Why Family Matters in Recovery Recovery from eating disorders, OCD, or anxiety isn’t a one-person job, it requires integrated care including the family. When families learn to navigate challenges together, they can model emotional regulation, reinforce healthy boundaries, and create conditions for sustained recovery. Through FIR, we aim to strengthen attachment bonds, reshape family interactions, and empower every member of the family to grow. The result is not only symptom reduction but also a deeper sense of unity, hope, and shared endurance, just like the steadfast fir tree that stands resilient through every season. Moving Toward Hope Family Inclusive Recovery invites caregivers and loved ones to become active participants in change. It’s a journey of learning, letting go, and leaning into love and acceptance. Together, families and clinicians can cultivate the courage in clients to face uncertainty, and in doing so, help them discover that recovery is not just possible, but enduring. If you’d like to learn more about Family Intensive Recovery at The Greenhouse or how we support families in eating disorder and OCD treatment, reach out to our team today.
November 14, 2025
The Greenhouse at Thrive Wellness A New Chapter of Hope and Healing in Nevada On Friday, November 14 , we gathered with our partners at Molina Healthcare to share an important moment for our community. Together, we celebrated Molina’s generous $50,000 grant , an investment that is helping bring The Greenhouse to life. Their support is not only a financial contribution—it’s a statement of belief in the young people and families of Nevada who deserve access to compassionate, evidence-based mental healthcare close to home. This gathering marked the beginning of something we’ve dreamed about for years: a place designed specifically for adolescents and emerging adults to receive the care, connection, and support they need during some of the most vulnerable moments of their lives. Something New Is Growing In early 2026 , Thrive Wellness will open The Greenhouse , Nevada’s first residential treatment center devoted to adolescents and emerging adults navigating eating disorders, anxiety, and OCD . For too long, families have faced a heartbreaking dilemma—send their child far from home for treatment or go without the specialized care they need. The Greenhouse is our answer to that gap. It will be a place where young people can settle into an environment built for healing, where they are understood, supported, and surrounded by a team that believes in their capacity to recover. The Greenhouse represents a natural extension of our mission. It’s a living expression of our belief that recovery is possible—and that with the right support, families can find their footing again. 
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