Understanding Your Mental Health Coverage
Insurance coverage for mental health benefits differs among plans, employers, and states. State laws may require insurers to provide a standard, minimal offering of mental health benefits. In general, mental health benefits are significantly less than medical/surgical benefits and will require higher deductibles and co-payments in addition to any regular, fixed payments. While an HMO may have multiple psychologists, therapists, or other mental healthcare providers on its staff, other plans may require use of doctors or practitioners in approved provider networks in your local area.
Covered Conditions
When navigating the maze of private health insurance, it's important to determine the category your child's illness falls into for your particular insurer and health plan. The issue of where OCD falls categorically may also be mandated by your state, so it's good to ask your insurer's benefits administrator first, and then double-check the state law. What follows are common definitions for different categories of mental health disorders used by private insurers when determining coverage. You might take a look to see whether any of this language is replicated in the print of your policy. The following groupings are listed for illustration of common insurance coverage:
Serious mental illness: Typically defined as schizophrenia, schizoaffective disorder, psychotic disorders, bipolar disorder and major depression (sometimes called mood disorders), personality disorders such as defiant or schizoid personality disorder, and anxiety disorders including panic disorders and obsessive-compulsive disorder, among others.
Broad-based mental health disorders: Used to refer to coverage of a relatively broad range of mental disorders.
Substance abuse disorders: Used to refer to coverage of alcoholism and chemical dependency.
Although these are common categories for mental health disorders, all insurance plans are different and require careful reading and follow-up with their benefits officers and/or directly with your assigned health and/or mental healthcare providers within the plan to find out the extent of coverage, meaning number of visits allowed, co-pays, and so on. After determining whether you can get adequate care under your insurance plan, you'll have to determine how much of your child's care will be paid for by your insurer and how much will come out of your own pocket.
