Let’s Talk About Mental Health and Insurance

Tuesday, May 18, 2021 | 03:28pm

Mental health and substance use disorders are very real, life-threatening, debilitating illnesses. And, with proper care, they are often treatable.

Tennesseans can feel more at-ease knowing many health insurance plans can help cover the cost of treatment for these disorders – helping relieve families of major financial burdens.

In light of Mental Health Awareness Month and the upcoming Insurance Awareness Day on June 28, the Tennessee Department of Commerce and Insurance (TDCI) encourages Tennesseans to know more about their coverage when it comes to mental health and substance use treatment.

How Insurance Coverage of a Mental Health and Substance Use Disorder Works

According to the Mental Health Parity and Addiction Equity Act of 2008, any health plan that covers mental health and substance use services must match its coverage with the plan’s physical health coverage.

This means the copays, deductibles, number of days for staying in a hospital or treatment facility, prior authorization, prescription drug tiers and maximum benefit limits must be the same for both mental health and physical health services.

For example:

  • If your plan covers 40 physical therapy visits, it must also cover 40 behavioral health visits.
  • If your plan covers 30 days of an in-patient hospital stay, it must also cover 30 days of an in-patient residential treatment stay.
  • If your co-pay for physical health services is $30, it must also be $30 for mental health services. 

This parity law was created to ensure fair coverage of mental health services.

This applies to a variety of health plans, including those on the Federally Facilitated Marketplace, large employer plans, individual plans and some small employer group plans.

Some health plans are exempt from this coverage. Contact your health insurance company to better understand your coverage.

What is Covered

Treatment for mental health may include therapy, in-patient and out-patient treatment, medication management for depression, schizophrenia, bipolar disorder, psychotic disorder and Applied Behavioral Analysis for the treatment of Autism Spectrum Disorder.

Treatment for substance use disorder from alcohol, tobacco and drugs may include detox medications, in-patient and out-patient treatment, step therapy, behavioral counseling and more.

Contact your health plan using the phone number on the back of your insurance card to get more details on your level of coverage.

If left untreated, mental health and substance use disorders can lead to physical illness, thoughts of self-harm, danger to others, accidental overdose and other life-threatening issues.

According to the Tennessee Department of Mental Health and Substance Abuse Services, the Tennessee Crisis Phone Line had more than 125,000 calls in Fiscal Year 2020. In Fiscal Year 2019, more than 20,000 Tennesseans used services for substance use treatment and recovery.

TDCI encourages anyone who is in immediate danger and has thoughts of self-harm to contact the Tennessee Crisis Line at 1-855-274-7471.

Questions or Concerns About Coverage

Tennesseans who find their insurance company is not covering these services the same way they cover physical services, or have other issues with claims related to mental health and substance use treatment, should file a complaint with TDCI.

Not only will filing a complaint potentially help resolve your case, it will also help TDCI understand the issues consumers face regarding insurance coverage. 

To file a complaint, visit tn.gov/insurance, select File a Complaint, then complete and submit the form. Make sure you have the policy number and names of those involved.

The Consumer Insurance Services team can serve as mediators between the consumer and the insurance company and may be able to help facilitate a solution.

In 2020, Consumer Insurance Services recovered more than $10 million from insurance companies for Tennesseans through mediation efforts.

For more information about insurance-related issues, call Consumer Insurance Services at 615-741-2218 or 1-800-342-4029.

Jennifer Ramcharan serves as Education and Outreach Specialist for the Insurance Division of the Tennessee Department of Commerce and Insurance. She can be reached at jennifer.ramcharan@tn.gov