With The Aim Of Making Mental Healthcare Available To All Irdai Has Asked Mental Illnesses To Be Included In All Regular Health Insurance Coverage
Given the significant emotional and financial consequences of COVID-19 in India, it is important to devote adequate resources and attention to the mental health needs of the people throughout the remaining course of the COVID-19 pandemic and most importantly, to prepare for any such pandemics in the near future. As per various researches and studies conducted in the last three months, a majority of people have shown signs of frustration on some level with the primary reason being not able to do what they normally enjoy doing.
An equal number of people seem to be worried about their own health apart from the health of their loved ones. A survey even revealed that adults younger than 50 were much more likely to report emotional impact of the pandemic compared to older adults. Most people are showing signs of panic and anxiety with a substantial number also reporting sleep disorders.
Are Any Services Excluded From Coverage
Although policies include inpatient rehabilitation or substance use care, they exclude long-term care. This type of service is defined as medical and non-medical care provided to individuals who can’t perform necessary daily living activities.
Many insurance companies also exclude elective procedures, experimental procedures, complementary medicine, and non-medical counseling.
Health Policies To Cover Mental Illness
- IRDAI has issued a circular directing insurers to cover mental illness
- Mental health conditions have always been in the list of exclusions of health insurance policies
- Companies wishing to include mental health coverage will have to file a fresh product with the IRDAI
Young Adults Get Insured
In 2010, the ACA began allowing young adults to remain on their parents health plans until age 26. This provision along with the expansion of Medicaid and premium subsidies in the health insurance exchanges has resulted in a sharp decline in the number of young adults without health insurance. According to US Census data, 22.1 percent of people aged 19-25 were uninsured in 2013, and that had fallen to 13.1 percent by 2016 .
Johanna Jarcho, Ph.D, is a postdoctoral fellow at the National Institute of Mental Health. She explains that the vast majority of mental health disorders do emerge during ones adolescence or early 20s. With the drop in the uninsured rate for young adults, treatment for mental health and addiction problems is much more within reach for this demographic than it was prior to the ACA.
But its not just young adults who have gained health insurance as a result of the ACA. From 2010 to 2016, the number of Americans without health insurance fell by 20 million people. A 2013 University of Minnesota study found that people with mental health problems are disproportionately represented among the uninsured. The ACAs success in means that a significant number of previously uninsured people with mental health problems have been able to obtain health insurance that covers mental health care.
Covers A Broad Range Of Mental Illnesses
Health insurance policies for mental disorders provide financial coverage for a broad range of mental illnesses, including Schizophrenia, Bipolar Disorder, Anxiety Disorder, Dementia, and Alzheimers disease. These disorders can interfere with a persons day-to-day activities and with the normal functioning of the human brain. The financial protection and the scope of mental health insurance coverage is a vital benefit for those requiring medical attention for the betterment of health.
Best For Customer Service: Kaiser
Why We Chose It: Kaiser Permanente earned the best for customer service choice because of their consistent industry ratings for excellent customer satisfaction and range of options like psychiatric care for people with mental, emotional, and substance abuse problems.
Access to mental health services without referrals
Unparalleled customer service
Coordinated insurance and health care
Personalized treatment plans
Limited to eight states
Health industry leader Kaiser Permanente states that mental health and wellness services are an essential part of someone’s total care experience. To that end, they provide a wide range of mental care options such as counseling and therapy, crisis intervention, addiction and recovery support, and help for eating disorders. This range of services coupled with their consistently high customer satisfaction ratings with J.D. Power and Associates made Kaiser our top customer service choice.
It is a managed care organization with its own network of 39 hospitals, 727 medical offices, and teams of psychiatrists, psychologists, therapists, and clinical nurse specialists. Members can see any provider without referrals.
There’s a range of therapy and treatment choices such as suicide prevention, depression and anxiety resources, counseling, therapy, and help for substance use on an inpatient or outpatient basis. Kaiser also provides online communities, support groups, podcasts, and wellness coaching to reduce stress.
Q: What Is The Health Insurance Marketplace
The Health Insurance Marketplace is designed to make buying health coverage easier and more affordable. The Marketplace allows individuals to compare health plans, get answers to questions, find out if they are eligible for tax credits to help pay for private insurance or health programs like the Childrens Health Insurance Program , and enroll in a health plan that meets their needs. The Marketplace Can Help You:
- Look for and compare private health plans.
- Get answers to questions about your health coverage options.
- Get reduced costs, if youre eligible.
- Enroll in a health plan that meets your needs.
Learn more at HealthCare.gov.
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Q: Does Medicaid Cover Mental Health Or Substance Use Disorder Services
Answer: All state Medicaid programs provide some mental health services and some offer substance use disorder services to beneficiaries, and Childrens Health Insurance Program beneficiaries receive a full service array. These services often include counseling, therapy, medication management, social work services, peer supports, and substance use disorder treatment. While states determine which of these services to cover for adults, Medicaid and CHIP requires that children enrolled in Medicaid receive a wide range of medically necessary services, including mental health services. In addition, coverage for the new Medicaid adult expansion populations is required to include essential health benefits, including mental health and substance use disorder benefits, and must meet mental health and substance abuse parity requirements under MHPAEA in the same manner as health plans. Find additional information on Medicaid and mental health and substance use disorder services.
What Kind Of Insurance Plan Do You Have
Most insurance plans either have a co-pay or deductible. A co-pay means you pay a set amount for each appointment, and your insurance covers the rest. A deductible plan means that you pay all your medical expenses up to a certain amount, at which time insurance starts covering a specific percent of your costs.
If your plan has a deductible, you will want to know how much each session will cost you before your insurance coverage starts. Most therapists post information about their rates on their website, but your insurance plan might have a negotiated rate with in-network providers. This means that your rate per session is discounted.
Options available to you depend on which company is your health insurer. Companies vary on what plans they offer and what services they cover. Since many people are insured through their employer, you might not get to choose which insurance company covers you and your family. Still, if you own your own business or purchase privately, you want to research your options before committing to a plan.
The cost of therapy varies significantly, with many providers in the United States charging between $65 to $200 per session. The cost depends on your location, the therapist’s training, and any specialized care you might need.
Usually, your insurance card lists which type of plan you have, but you can get this information from their website or by calling the customer service phone number on your card.
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How Can I Get Free Or Low
When it comes to finding a counselor, start at school.School counselors and school psychologists can provide a good listening ear for free! They can help you size up the situation you’re dealing with and, if needed, refer you to more support in your county or community.
If you need more help, the school counselor may be able to point you in the right direction. Some possibilities to explore include:
If you’re under 26, your mental health care should still be covered under your parent’s insurance policy. It’s worth a call to the insurance company to find out what services the policy covers and how much of those services it pays for.
Register And Log On To Your Insurance Account Online
Your health insurance plans website should contain information about your coverage and costs you can expect. Since insurers offer a variety of plans, make sure youre logged on and viewing your specific insurance plan.
If youre required to choose a therapist thats in your plans network, a list of providers should be available online. You can also call and ask that a local list be given to you by phone or mail.
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Universal Health Coverage In India
India, being a member state of the United Nations, is bound to implement the United Nations Sustainable Development Goals agenda by 2030 and Universal Healthcare Coverage is one of those goals. In fact, UHC cuts across all the health-related SDGs. UHC essentially means that every person can use the promotive, preventive, curative, rehabilitative, and palliative health services they need, of sufficient quality, while also ensuring that the person does not get exposed to financial hardships while achieving this. UHC brings the hope of improved health and financial protection of the poorer sections of the society. Governments now have an obligation to make such health services available.
What To Know About Common Insurance Coverage For Therapy
If you have health insurance through your job, it may or may not include coverage for therapy. Even if you have coverage, its up to you to decide whether or not you wish to use it for mental healthcare. In some instances, people choose to pay out of pocket for therapeutic services rather than claim coverage through their insurer. Why?
Insurance companies only pay for medically necessary services. They require a mental health diagnosis before they will pay claims. Some people are not comfortable with this.
A mental health condition diagnosis may range from acute stress to insufficient sleep syndrome, various phobias, mental illnesses, or a number of other descriptors. When it comes to insurance, each of these would have a code number that would go with an insurance claim.
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Still Work To Be Done
The ACA has dramatically increased coverage for behavioral health treatment. But the National Alliance on Mental Illness continues to bring attention to the challenges people face in obtaining mental health care, despite the changes that the ACA imposed.
Although insurance coverage with behavioral health benefits is much more widespread than it used to be, access to care is still limited in some circumstances. In many states, theres a shortage of mental health providers, which is magnified in rural areas. Shel Gross noted that two- to three-month wait times are not uncommon when new patients are seeking an appointment with a psychiatrist.
A 2017 Milliman study found that mental health care is much more likely than other medical care to be provided out-of-network, and insurers tend to reimburse mental health providers less than they reimburse primary care providers. Largely as a result of what the providers see as low reimbursement rates, nearly half of private psychiatrists in the US dont accept any health insurance at all theyre out-of-network no matter what insurance the patient has. When Milliman revisited this issue in 2019, they found that the out-of-network problem was persisting, and appeared to be worse than ever.
The mental illness with the highest mortality rate is anorexia nervosa. And yet patients continue to face insurance-related barriers that prevent them from receiving residential treatment for anorexia.
Getting Help From Parents And Other Adults
Navigating your way through the health care system can be confusing . That’s why it’s a good idea to have a parent, relative, doctor, school counselor, or social worker help you connect with a mental health professional.
But what if you want to get counseling without a parent knowing? In many states, teens can get mental health treatment without parental consent. When you call a clinic, hospital, or therapist, ask about your state’s rules on parental consent for mental health services. When you see a counselor, find out about the rules when it comes to filling a prescription. Even if you can get confidential care, your parents may need to give the OK to fill prescriptions.
Whatever happens, don’t let money hold you back from getting help. Affordable mental health care options are out there it may just take some time and effort to find them. But don’t give up. Mental health care can help you work through stress and get needed treatment for mental health problems.
Providing Medical Records To The Insurance Company
The health insurance company gets access to medical records of persons with mental illness. The medical records such as procedure done, investigations, diagnosis, and treatment are specifically needed for payment of claims. The insurance company may request medical history related to symptoms and prior treatments in order to justify the insurance coverage. However, there are no guidelines or regulations regarding how much medical records should be shared or what information can be shared. If the medical records are shared with the insurance company, will it be the contravention of the MHCA, 2017 section 23, right to confidentiality? These issues need to be clarified for the proper implementation of health insurance for mental illness.
A lot of these queries do not have a straightforward solution. One-way forward is to follow the guidelines given by the state or central governments as discussed earlier. Furthermore, the Insurance Regulatory and Development Authority of India has notified a relevant policy. This states that the insurers are free to come up with their own packages for the initial few years. Data about their utilization will then be studied to guide further developments.
It may be concluded that, treating mental illness at par with physical illness by mandating provision of health insurance for mental illness is no doubt a welcome change however a considerable amount of thought will have to be put into working out the details.
Does Insurance Cover Bipolar Disorder
The act also requires many health insurance companies to cover people regardless of their pre-existing conditions, whether physical or psychological. This means that people with bipolar disorder are now able to receive quality insurance coverage, so they can get the psychological treatment their condition requires.
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Reviewing Your Insurance Policy
The first thing to find out is what mental health benefits your insurance policy offers. Review your insurance policy so that you are clear about whether your policy includes coverage for mental health services, types of services that are covered and the amount paid for these services, and any steps you must take to have treatment covered. You should have received a copy of your insurance policy when you enrolled in the program, whether at work or independently. If you did not receive a copy of the policy or have lost yours, you can call your insurance company and ask for another one to be sent to you.
Even if you have a copy of the plan, it is always helpful to speak to someone else and clarify questions. This way you can identify any possible points of confusion before you receive a bill. You should have a number on your card or on the website that will tell you whom to contact.
The following are some questions you will want to ask your insurance company, if possible, before starting treatment:
1) Do I need a referral from my primary care physician to a mental health professional?
Many insurance companies, especially Health Maintenance Organizations require referrals from a primary care physician to visit any specialist, including mental health professionals. If you do not receive a referral before visiting a mental health professional, your insurance company may deny your claims. If you think you require a referral, you should always get it in advance.
Do You Have Insurance Questions About Mental Health Or Addiction Services
Help is available, if you have:
- Been denied coverage
- Reached a limit on your plan
- Have an overly large copay or deductible
You may be protected by Mental Health and Substance Use Disorder Coverage Parity laws require most health plans to apply similar rules to mental health benefits as they do for medical/surgical benefits. Select your insurance type below for more about the protections that apply for you, and to get assistance information. There are Federal and State Agencies who can provide assistance.
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Waiting Period Exemption For Higher Benefits
If you are on a hospital policy which provides restricted benefits for psychiatric care, then to access higher benefits you usually upgrade and complete a two month waiting period.
However, from 1 April 2018, you can upgrade without having to serve this waiting period to access higher benefits for psychiatric care in a private hospital.
This exemption applies only once per lifetime and can only be accessed if you have already completed an initial two months of membership on any level of hospital cover.
For more information about accessing the exemption, please contact your health fund.