Are psychologists covered by health insurance?

“To sum it up…”

Different insurance companies may have different policies regarding coverage for psychologists
The mental health parity law passed in 2008 and requires insurers to offer coverage for mental and behavioral health services equivalent to what they offer for physical health services
The Affordable Care Act also lists mental health treatment and addiction services as one of the ten essential health benefits that insurance companies are required to cover
Some mental health diagnoses may be excluded from coverage depending on the insurer
Psychologists are not required to accept your health insurance

Are psychologists and mental health services covered by my health insurance?

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Most health insurance plans cover mental health services and psychologists, particularly if they are in compliance with the federal mental health parity law and the Affordable Care Act. You can look through the description of your plan benefits or call your insurance representative to find out exactly what your plan covers in regards to mental health issues and substance abuse treatment.

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What is the mental health parity law?

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The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act, more commonly known as the mental health parity law, passed in 2008 and requires insurance companies to cover services for mental health issues, as well as substance abuse disorders, the same way that they cover services for physical health problems.

This means that your insurance company cannot require you to pay a higher co-payment for mental health services than for a visit to most of your medical or surgical providers. Sometimes, a visit to your primary care provider can require a lesser co-payment, which is not a violation of the law.

Additionally, this law prohibits insurance companies from setting annual limits on how many times you can see your mental health provider in a year. Your insurer may still pose some limits on how often you see your psychologist or another mental health specialist, based on the medical necessity of your condition.

The law affects employer-based coverage for companies with 50 or more employees. It also affects the Children’s Health Insurance Program, as well as most Medicaid programs.

There are limited-coverage Medicaid programs that would not comply with this law. Any coverage purchased through the Affordable Care Act Healthcare Marketplace must also be compliant with this law. Medicare is exempt from these regulations, as are some government sponsored plans.

How does the Affordable Care Act affect coverage of mental health problems?

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Mental health services are one of the 10 essential health benefits that must be covered under the Affordable Care Act. Addiction and behavioral treatment fall under this mental health services category. This includes both inpatient and outpatient services that you might require in order to diagnose, treat, or just evaluate any mental health issues you are suffering from.

Counseling and psychotherapy are both required coverage under the Affordable Care Act minimum essential coverage regulations. Psychologists often perform these services and therefore psychologists will be covered by most insurances that comply with the Affordable Care Act standards.

Some of these plans may limit coverage to 20 days a year. However, the plan must be in compliance with the federal parity mental health law, as well as your state parity laws, when it comes to annual limits.

Are specific disorders not covered?

Although the parity law is meant to apply to all mental health and substance abuse disorders, some insurance plans may exclude some specific physical or mental diagnoses.

These exclusions should be laid out to you by your health insurance and you should contact your insurer if you have any additional questions.

How will the payments and reimbursements work?

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Many insurance companies require you to meet a deductible for the year that you must pay out of your own pocket before your health insurance will make any payments. Before these laws came into effect, many insurance companies required you to meet higher deductibles for mental health services.

The mental health parity law now requires insurance companies to set one deductible for both physical and mental illnesses. Depending on your insurance plan and the circumstances, you may receive payment towards mental health treatment prior to your deductible being met, but not towards your physical health treatment.

Is my psychologist required to take my insurance?

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Your psychologist is not required to take your insurance even if mental health services are covered by your plan.

Reimbursement rates have not increased for mental health providers in recent years and some companies have decreased their reimbursement rates, so many psychologists and mental health providers do not participate in many insurance network plans.

Mental health is just as important as physical health; you deserve an affordable plan that can cover your body and mind at all times. Enter your zip below for a free personalized health insurance comparison.