How To Evaluate Medical Insurance Options for Mental Health Coverage

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Sifting through the maze of medical insurance options can feel like a monumental task, especially when factoring in coverage for mental health services. For too long, discussions around healthcare have marginalized mental wellness, treating it as less critical than physical health.

Yet statistics paint a dire picture: one out of every five adults in the United States grapples with mental illness each year, and countless others avoid seeking help due to high costs or lackluster insurance coverage.

As we reckon with the psychological impacts of a global pandemic, reassessing the mental health aspects of insurance policies isn't just advisable; it's crucial. The old perspective of sidelining mental health coverage no longer suffices.

Today, ensuring a comprehensive mental health inclusion in your insurance policy is as vital as making sure you're covered for surgeries or urgent medical care.

Dr. Goldenberg, a top psychiatrist based in Santa Monica, California and serving patients across California and the state of Alaska by telehealth, has compiled a list of essentials, as you review your insurance options and understand your policy. Dr. Goldenberg evaluates depression, anxiety, OCD, PTSD, ADHD and a host of other mental health conditions and is an expert in the evaluation and treatment of addiction. He is an advoacate for mental health parity and increased access to quality mental health and addiction treatment. 


Coverage of Mental Health Services: What to Look For

Exploring mental health coverage within insurance policies demands a sharp eye for specifics. While glossing over fine print might be tempting, missing a crucial detail can result in financial strain or limited care.

Therapy/Counseling: Verify the Number of Sessions Covered

Insurance policies may cap the number of therapy or counseling sessions you can attend each year. Some may offer an adequate number, say 52 (one per week), whereas others may offer far less. Understand what your prospective policy offers and ask yourself if it meets your needs. 

Medication: Assessing the Drug Formulary Related to Mental Health Medications

From improving sleep to stabilizing mood swings, taking the right medications can help your mental health. Examining the drug formulary—essentially a list of medications the insurance covers—is imperative. Does it include medications you're currently taking or might need for conditions like depression, anxiety, or bipolar disorder? Some policies might only cover generic options, which may or may not suit your needs.

Emergency Services: Importance of ER Coverage in Crisis Situations

In moments of acute mental distress, emergency room visits become not just likely but essential. Ensure that your policy covers ER visits related to mental health crises. Examine the fine print to check whether higher copayments or separate deductibles apply in these situations.

Hospitalization: Details to Consider When Inpatient Care is Required

Mental health conditions may require inpatient care, either for stabilization or longer-term treatment. Look for policies that offer comprehensive coverage for psychiatric hospitalization. Inquire about the duration of stay covered and what types of facilities are included in the network.


Deciphering the Costs

Achieving mental wellness can be a costly endeavor, but with the right approach, it can be more affordable. The monetary aspect of an insurance plan is equally as critical as its coverage features. Deciphering the various costs involved is essential for making an informed decision that balances financial feasibility with healthcare needs.

Premiums: The Monthly Commitment

The monthly premium is often what catches your eye first. While a higher premium often suggests more extensive coverage, this isn't a hard and fast rule. Balancing this monthly expense against the services offered is crucial.

Copayments and Coinsurance: The Cost of Appointments and Medication

These are your share of the costs for medical services and prescriptions. Copayments are fixed sums, whereas coinsurance is a percentage of the total expense. The figures can differ widely depending on both the policy and whether your healthcare provider is in-network.

Deductibles: Your Initial Out-of-Pocket Expense

This is where understanding the different types of health insurance matters. For instance, a quick look at POS healthcare meaning would reveal that it does not require meeting a deductible before the insurance kicks in. This will help you save money while enjoying flexibility.

Out-of-Pocket Maximum: The Safety Net

The out-of-pocket maximum is your financial safeguard. It's the highest sum you'd have to pay within a year before the insurance takes care of the rest. For anyone expecting to require extensive or costly treatments, understanding this component is vital.


Evaluating Provider Network

The task of choosing a suitable insurance policy isn't just about numbers on a page. It's also about the human element—the professionals you'll be relying on for guidance, support, and treatment. Therefore, evaluating the provider network is paramount.

Importance of a Broad Network of Mental Health Professionals

A diverse, expansive network implies a rich set of options for therapists, psychiatrists, and counselors. The benefits are manifold: not only do you have a higher likelihood of finding a practitioner whose expertise matches your needs, but you also enjoy the luxury of choice in case your initial choice doesn't align with your expectations.

The Drawback of a Narrow Network, Especially in Less Urban Areas

On the flip side, a narrow network can be severely limiting, more so if you reside in a less urban area where options are already scarce. Here, you could end up with a practitioner who might be the only available option rather than the best fit for your needs. The implications could range from ineffective treatment to increased travel time and costs for seeking care outside the network.

Tips for Ensuring Your Preferred Therapist/Psychiatrist is In-Network



Nonetheless, some plans will allow you to consult with out-of-network providers and will let you reimburse the costs. This makes it more important to thoroughly analyze what your plan covers.

How Dr. Goldenberg Can Help Your Mental Health Journey

Navigating the intricate corridors of mental healthcare can often leave one overwhelmed. While insurance plays a pivotal role, the quality of care you receive is ultimately paramount. Dr. Goldenberg and his team of qualified therapists offer an alternative route—one that emphasizes personalized care, albeit with a distinct financial model.

While Dr. Goldenberg does not accept any form of insurance in his private practice, including Medicare or Medi-Cal/LA Care, for those with PPO insurance plans, there is financial flexibility. Dr. Goldenberg can provide you with an invoice/"superbill" that you can submit to your PPO Insurance for possible "out of network" coverage. This allows you to potentially recoup some, or all, of the costs, of the appointments. 

If you are interested in working with Dr. Goldenberg, you can schedule a free 10-minute phone consultation using the link above. 

Matthew Goldenberg, D.O. Matthew Goldenberg D.O. is double Board Certified in Psychiatry and Addiction Psychiatry and is a certified Medical Review Officer (MRO). He is an expert in the evaluation and treatment of mental health disorders and is an addiction specialist for adults in his private practice in Santa Monica, California. Dr. Goldenberg also provides addiction psychiatry consultations to some of the nation’s top residential and outpatient treatment programs in the Los Angeles area and is experienced in the evaluation and treatment of professionals working in safety-sensitive positions. In addition to his clinical work, Dr. Goldenberg is an active author, researcher and invited speaker at local and national conferences. He also volunteers his time as a Clinical Instructor in the Department of Psychiatry at UCLA and is an Assistant Professor of Psychiatry at Cedars Sinai Medical Center.

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