Does insurance cover psychiatrists?
Health insurance generally covers mental health issues, but there are a few things you need to know.
Key takeaways
- Whether you have a healthcare plan through work or private plan you bought on the insurance marketplace, it should include mental health coverage.
- Seeing doctors who are in-network with your insurance company can help lower costs.
- Make sure to read the details of your plan, since the health insurance coverage can get very specific.
If you struggle with your mental health, seeing a psychiatrist can make a huge difference in your overall well-being.
Mental health conditions are extremely common, affecting more than 1 in 5 US adults today. A psychiatrist can assess your mental health, diagnose you with a condition, and come up with a treatment plan to help you feel better. The good news is that your insurance plan can help cover the cost of these essential services, making mental health care more affordable and accessible.
Here’s what you need to know about insurance and mental health coverage, specifically for psychiatrist visits.
How do insurance companies cover mental health?
Thanks to The Mental Health Parity and Addiction Equity Act of 2008, insurance providers must provide mental health coverage comparable to the physical health coverage they offer. This law was a game-changer, recognizing the importance of mental health care. Prior to this, insurance companies offered far less coverage for mental health services, preventing people from getting the life-saving care they need. Mental health parity tries to ensure that insured individuals in the United States can get the help they need, both physically and mentally, without facing financial discrimination.
Furthermore, the Affordable Care Act stated that mental and behavioral health services are “essential health benefits.” This includes substance use disorder treatment, too.
Common psychiatric services typically covered by insurance include:
- Initial psychiatric evaluation
- Medication management
- Outpatient psychotherapy (talk therapy)
- Emergency care
- Intensive outpatient services
- Partial hospitalization
- Inpatient/residential treatment
- Prescription medications
Keep in mind that every insurance plan is different, and mental health benefits may vary.
Does insurance cover online psychiatry?
In this day and age, telehealth has become the norm. Since the COVID pandemic, there’s been a major shift in how we receive health care, including mental health care. Because of this, most insurance companies recognize the benefits of telehealth and teletherapy, covering these services the same way they cover in-person services.
To make sure you can receive covered online therapy or telepsychiatry, you’ll want to double-check your plan’s mental health benefits. If you’re unsure, call member services to confirm.
Are you looking for an online psychiatrist? Consider Talkiatry. We are a national psychiatry practice that treats various mental health conditions, and we’re in-network with over 60 major insurance companies. You can check if we accept your insurance with our insurance checker here.
Understanding your insurance coverage limitations
Every insurance company operates a bit differently. Different insurance providers, and even different plans within a specific provider, may have different limitations in insurance coverage for psychiatric care.
Some examples of possible limitations include:
- Prior authorization: Certain plans may require prior authorization before you start treatment. This is when your insurance has to approve the treatment and determine it is necessary. Prior authorization may also be necessary for prescription medications.
- Number of sessions: Depending on your plan, there may be some limits to the number of allowed sessions. In general, the Mental Health Parity Act prohibits insurance companies from putting a hard limit on the general number of mental health office visits or telehealth visits you can have. However, your insurance might require more authorization to determine if continued treatment is medically necessary after a certain number of sessions.
- Out-of-network benefits: Many psychiatrists mental health professionals are in-network with insurance. However, some are out-of-network. In that case you may still be able to see them, but you’ll have to pay more, depending on how your insurer covers services from out-of-network doctors. If your insurer doesn’t offer out-of-network benefits, you’d have to pay full price for services. That’s why it’s usually best to find someone in-network.
Out-of-pocket costs
It is common to still have out-of-pocket costs for mental health care, such as:
- Your copay: The flat fee you typically pay at the time of your visit. Your copay might differ for mental health services, primary care, and specialists. When you’ve spent enough money out-of-pocket and met your deductible, you typically still pay these costs, but it depends on your plan.
- Your deductible: The amount of money you must spend out-of-pocket before your insurance starts to pay for services. Typically, the higher your monthly premium, the lower your deductible.
- Your coinsurance: This is a percentage amount that dictates how much you’ll have to cover for services out-of-pocket. For example, your plan might cover 80% of the cost, and you only have to pay 20%. Your coinsurance amount may also change once you reach your deductible.
Ultimately, your best bet is to thoroughly review any documents you have that explain your mental health benefits. There, you can find information about your covered services, copays, deductible, coinsurance, and more. If you have any trouble finding that information, call your insurance’s member services phone number.
To learn more, check out: How much does.a psychiatrist cost
How do you get referred to a psychiatrist?
In some cases, you may need a referral to see a psychiatrist. Certain insurance plans require a referral to see any specialist outside your primary care provider. This is most common with HMO plans and less common with PPO plans.
If your plan requires a referral, you will have to see your primary care doctor, who will then give you a referral to schedule an appointment with a psychiatrist. By going through this referral process, you can ensure that the necessary mental health services are covered. By working with a psychiatrist to receive a diagnosis and a treatment plan, you can improve your mental health and change your life.
For more information, check out how to find:
FAQs
Do Medicare and Medicaid cover mental health?
Yes, both Medicare and Medicaid cover mental health care. The exact benefits will vary based on specific plans. This includes care from a psychiatrist, such as initial evaluation and medication management.
Does insurance coverage differ based on type of insurance plan?
Yes, insurance coverage can change wildly depending on your insurance company and specific plan. This can impact factors such as whether or not you need a referral to see a psychiatrist, your deductible, your copay, if you have out-of-network benefits, and more.
The information in this article is for education and informational purposes only and should never be substituted for medical advice, diagnoses, or treatment. If you or someone you know may be in danger, call 911 or the National Suicide and Crisis Lifeline at 988 right away.
