One of the most important things to consider when seeking mental health treatment is insurance coverage. In the United States, mental health insurance coverage is a piecemeal patchwork, with some states and plans providing better coverage than others. However, there are federal and state laws in place that guarantee some mental health coverage for all Americans.
Understanding the different types of mental health coverage is the key to finding the best option for you or your teen’s needs. We never want the cost of treatment to be a barrier to mental health care, so we’re here to help you navigate the essentials of insurance coverage for behavioral health. You can quickly check your eligibility with us through our insurance checking tool and find out what else you need to know here.
Understanding Mental Health Insurance Coverage
Unless you’re on Medicare or a state-provided plan, your insurance coverage for mental health services is dictated by a private company. Your benefits summary will explain in detail what is covered by your plan. You may see some terminology you’re not familiar with, so we’ll do our best to explain it here:
- Outpatient Care: Any service administered without an overnight stay in a hospital facility or setting
- Inpatient Care: Any service administered that does require an overnight stay, including residential treatment
- Out of Network: Any doctor, hospital, or service provider that is not covered by your insurance
- In Network: Any doctor, hospital, or service provider that is fully or partially covered by your insurance
- Copay: A flat fee you pay for treatment, usually at the time of service. Copays can affect both services and prescriptions.
- XX% Coinsurance: This dictates the percentage of the overall cost you pay for a particular service or medication
- HMO & PPO Insurance Coverage for Behavioral Health
The details of your mental health insurance coverage, like which providers are in or out of network, are usually dictated by the type of plan you have. The two most important types of coverage are called HMO and PPO.
PPO plans, or preferred provider organizations, allow you to see any mental health provider that accepts your insurance without needing a referral from a primary care doctor. However, you may have to pay more for mental health services if you see an out-of-network provider.
HMO plans, or health maintenance organizations, are more restrictive, as you must get a referral to a mental health provider from your primary care doctor. Even with a referral, you must receive treatment from someone who is in your insurance network.
Ascend accepts any PPO plans and is in-network (accepts HMO plans) with the following:
- First Health
- Anthem Blue Cross Blue Shield
- Kaiser Permanente
Medicaid & Medicare Coverage for Mental Health
Medicaid is a federal and state insurance program that provides health coverage to low-income Americans. Medicaid mental health insurance coverage varies from state to state, but all states must provide mental health services to children. In some states, Medicaid mental health insurance coverage is available to adults as well. To be eligible for Medicaid, you must meet your state’s income and asset guidelines. You can apply for Medicaid through your state’s Medicaid office.
Medicare is a federal insurance program that provides health coverage to seniors and some disabled Americans. Medicare mental health coverage is limited, but it does cover some services.
Mental Health Treatment at Ascend
Ascend’s residential mental health treatment programs provide comprehensive mental health care for teens, and they’re covered by many insurance plans. We work hard on our end to ensure every part of their personalized treatment is covered, often rebilling providers even after a denial.
If your teen is struggling with mental health or behavioral issues, we can help. Our mental health treatment programs can provide the support and resources your teen needs to heal and thrive.