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How Health Insurance Covers Mental Health Treatment

In the past, those suffering from mental health concerns often felt swept under the rug, with services difficult to obtain and health insurance coverage lacking. The good news is that a lot has changed in recent years, and all Californians should know their rights regarding mental health services.

We now recognize that mental health is just as important as physical health. And the law agrees: The Affordable Care Act defines mental and behavioral health services as “essential” and requires health insurance providers to cover them under ACA-compliant plans.

Under federal law, essential services include:

  • Treatments such as counseling and psychotherapy
  • Inpatient mental and behavioral health services
  • Substance abuse treatment

Covered services are subject to the same standards as medical and surgical services, regarding the way care is managed and how deductibles and co-pays are applied.

Additionally, California law dovetails with federal law, requiring all health insurance plans within the state to cover treatment for the following mental health conditions:

  • Major depressive disorders
  • Autism or pervasive developmental disorder
  • Bipolar disorder
  • Panic disorder
  • Schizophrenia
  • Schizoaffective disorder
  • Obsessive-compulsive disorder
  • Anorexia nervosa
  • Bulimia nervosa
  • Serious emotional disturbances in children under age 18

Healthcare plans must offer inpatient services when needed, outpatient diagnosis and treatment, and prescription drugs – the same as any other covered medical condition.

Finally, California law requires that mental health and substance abuse professionals offer you a return appointment within 10 business days of your initial assessment. This deadline also refers to referrals to mental health services from your primary care provider. By law, mental health conditions are taken seriously, and prompt help is not only available, but required to be provided.

If you’re in need of mental health or substance abuse services, don’t delay. Reach out for the services you need, just as you would with any other medical event, and rest assured that your rights are protected by both federal and state law.

If you have any questions about your plan coverage for mental health services, don’t hesitate to call us for help.

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