Using Insurance for Mental Health Services: 6 Questions to Ask About Your Plan

A law passed in 2008 known as the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equality Act (or Mental Health Parity Law) requires insurance coverage of mental health, behavioral health, and substance-use disorders to be comparable to physical health coverage. Despite these changes, people often remain unaware of the mental health services that may already be covered by their existing insurance.

If you are interested in learning more about your Mental Health Benefits, it is a good idea to contact the Behavioral Health or general Customer Service number on your insurance card, even before your first appointment. The following questions will help you gather useful information about your plan and covered Mental Health Benefits:

1. Will I or my provider (psychologist) be required to provide any information for Preauthorization?
   
2. Does my plan require me to meet a deductible before my benefits apply?
   
3. What is my co-pay?
   
4. Is there is a limit on number of sessions covered, or covered per year, on my plan?
   
5. Are assessments covered, or only covered with a doctor's letter stating the medical necessity of an assessment (for example, to determine whether ADHD symptoms might be best treated by behavioral interventions or by medication)?
   
6. What is the process for me to submit out-of-network claims for reimbursement if I choose a provider who is not in my network?

Click here to learn more about mental health coverage under the Mental Health Parity Law in this guide published by the American Psychological Association.