Paying for Mental Health Care
Unless you are independently wealthy, you will probably rely on health insurance or government programs to pay for mental health care. There are multiple sources of benefits available to you. A psychiatric social worker or your case manager may be able to guide you to programs and benefits for which you may qualify.
Potential Sources of Health Benefits
Private health insurance or health maintenance organization
Veterans administration benefits
Social security disability insurance
Supplemental security income
Public assistance (welfare)
Medicare
Medicaid
Community Mental Health Centers (CMHCs), located in every state, may also provide treatment opportunities. They accept payment based on your insurance coverage, income or financial resources, and eligibility for other types of assistance.
Private Insurance and Veterans Administration Benefits
Private health insurance and health maintenance organization (HMO) plans are provided by a private insurance company or agency. Insurance is usually obtained through an employer because group rates are less expensive than those for individual policies. Individuals can also sign up on their own. Employers who do not offer a full health insurance plan may pay some of the cost of subscribing to a health plan.
Question
What is a clinical social worker?
A clinical social worker is trained to help clients obtain mental health resources. He can determine eligibility and need. In some cases, he may work as a case manager to coordinate care and services provided by multiple agencies, provide information, refer you to other sources of help, and intercede for you when dealing with government and insurance agency red tape.
You should receive a contract that explains the details of your benefits when you sign up for health care coverage. Many people either don't read their contracts or gloss over them. Don't make that mistake. Read the contract carefully, especially the parts that define coverage for mental health benefits. Find out exactly what your mental health care benefits are.
Health insurance coverage varies greatly according to the insurance provider and how much your employer is willing to pay to help defray your costs. It may cover nearly all of your medical needs or it may provide only partial coverage for the most serious. The amount you have to pay when you use the services can also vary widely. It is important that you know exactly what you signed up for and, if possible, begin supplementing your coverage to cover holes in your policy. If that is not feasible, start investigating other options.
Veterans Affairs Benefits
If a veteran is affected by schizophrenia, she may be eligible for Department of Veterans Affairs (VA) benefits. Contact the VA at (800) 827-1000 to determine if you or someone you care for qualifies. You can search for nearby VA treatment facilities online at
Social Security
Social security disability insurance (SSDI) and supplemental security income (SSI) are government programs that may provide financial assistance if you qualify. In 2002, more than one in four people receiving SSDI benefits had a mental disorder, totaling 1.7 million people at a cost of $18 billion. If a patient worked in the past and accumulated credits with the social security system, he may be eligible to receive financial assistance regardless of his present income. You might also investigate the possibility that a parent's contribution to social security can qualify an ill child for benefits.
If SSDI is not an option and you don't have much money or income, you might qualify for SSI. In 2002, nearly one in three people receiving SSI had a mental disorder, totaling 1.6 million people at a cost of approximately $8.2 billion.
Contact the Social Security Administration Office in your area to find out which, if either, of these programs might help you. To find the nearest office, you can call the automated telephone service at (800) 772-1213 or enter your zip code into the Social Security Office Locator website at
Public Assistance (Welfare)
Welfare, like schizophrenia, has a stigma attached to it. And like the stigma associated with schizophrenia, it is unfounded and unfair. The stigma is associated with healthy people, capable of working, who were accused of abusing the program.
Low-income patients have a right to this basic government assistance program. Take advantage of it if you qualify. You will need to check your phone book for the Office of Public Assistance nearest you or ask your case manager or other health care provider for information.
Alert
If you have no insurance or if your financial means are limited, ask your case manager if there are any patient assistance programs in your state that can help you obtain medications free or at a reduced rate.
Medicare and Medicaid
Medicare (medical insurance for the elderly) is another program offered through the Social Security Administration. If you have been collecting SSDI benefits for a couple of years, ask if you qualify for this program.
Medicaid programs (medical insurance for low-income patients) are administered by individual states, which determine what services are offered and who can receive them. Contact your local state health department for information about your eligibility and potential benefits. You can find that information on the Health and Human Service's Centers for Medicare and Medicaid Services website:
