If you feel your child could benefit from therapy and/or psychiatric medication management, your first step should be to contact your insurance company to find out how to proceed. The telephone number for member services is generally found on the back of your insurance card, in member materials you received when you enrolled, or on your insurance company's Web site. If you have trouble knowing who to contact, check with your employer's Human Resources (HR) representative.

Determine Your Benefits

First, you will want to make sure you have mental health benefits, and you need to find out what the limits of coverage are. In some cases, your primary insurance company will have contracted with an agency that manages mental health benefits, so you may have to make a second call. Important questions to ask are:

• Am I restricted to a list of providers “in network,” or am I free to use any provider?

• If I have out-of-network benefits, how do they work?

• Do I have a co-pay, deductible, or co-insurance cost for services?

• Is there a limit on the number of visits, and if so, what is it?

• Do I need a certification or prior authorization to proceed?

• Do you have a list of providers in my area?

Finding a Provider

As you've learned, finding a provider by word-of-mouth referral may be the best way to ensure that you will have a good therapy experience for your child. However, trusted friends or family may not have the same insurance coverage, and the provider they recommend may not be in your network. If you have a specific clinic or provider name, by all means, call your insurance company to check on coverage. The clinic or provider should be able to answer this question directly as well. If the provider does not accept insurance, she should be able to give you a receipt for services so you can submit this to your insurance company. In this case, if you have “out-of-network benefits” you should get some reimbursement. Chapters 8, 9, and 10 offer additional resources for locating providers.

What Is Mental Health Parity?

President Bill Clinton signed the Mental Health Parity Act (MHPA) into law in 1996. It is considered a landmark in health reform, and it received unprecedented bipartisan support. The MHPA eliminated a longstanding practice for insurance companies to offer lower rates of reimbursement for mental health as compared to physical health. It requires that annual or lifetime dollars spent on mental health benefits be no lower than dollar limits for medical or surgical coverage offered by group health plans. The mandate covers employers with fifty or more employees, and does not include coverage for substance abuse. It does not require your insurance provider to offer mental health benefits if they are not already part of the plan.

What If You Don't Have Insurance?

Most providers are happy to accept clients who pay out of pocket, and some may negotiate with you for a reduced rate because your direct payment reduces their billing costs. In many areas, there are larger clinics that receive local, state, or federal funding, which allows them to offer clients a sliding fee scale based on financial need. Although federal funding and standards are limited, there are many state and some local programs regarding insurance coverage for children. Examples include tax credits for individuals and employers to cover health care, increasing the age of dependent coverage, expanded options for covering children, and premium assistance for lower-income families. For more information, ask the school social worker for information, or call your state or county human services department for guidance on this issue.