Affordability of Mental Health Care
Until new federal legislation goes into effect in January 2010, many health insurance policies are likely to exclude nondiscriminatory coverage for mental illness. Call your insurance provider or HMO to find out what kind of coverage it offers. It is also important that you have the power to choose your own psychiatrist. If you can afford it, it may be worth it to pay to see one who is not approved by your insurance company. Compare plans and, if you have the option, switch to one with the coverage that best meets your needs. Ask the following questions before you sign up for a health plan:
Is the coverage for mental illnesses the same as that for other medical illnesses?
Will it pay for all the medical services and treatments you might need?
Will you be able to appeal if the insurance company decides you don't need a certain treatment?
Do you have to go through a general care physician before you can see a psychiatrist or the mental health care provider you want to see?
If a favorite psychiatrist is not approved by your health insurance company, can she sign up to be included on the list of approved providers?
Source: the American Psychiatric Association
If hospitalization of the patient seems necessary, you will have to get your insurance company to agree to the hospitalization before it will pay for it. Employees of the insurance company may go over the patient's case with the psychiatrist. If they agree that the patient's symptoms are so severe that she cannot be treated effectively in an outpatient setting, the insurance company will agree to pay for a short hospital stay.
The patient's mental state will be re-evaluated before the patient is released, and hospitalization may be continued if the doctor and the insurance company agree it is needed.
If you disagree with the insurance company's decision to deny payment for either first-time hospitalization or continuation of inpatient care, you and the patient's doctor have the right to appeal the company's decision.
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