Mental illness awareness has improved significantly over the last few decades. While things are still a long way from perfect, the stigma that has kept people with mental health difficulties at arm’s length from a social standpoint is largely abated.
In a not-so-M. Night Shyamalon-like twist, however, insurance has been much slower to come around. Even really good coverage plans are often skimpy when it comes to mental health coverage. Unfortunately, this means that even people who want to pursue care are often held back by financial barriers.
In this article, we take a look at how you can advocate for yourself and secure mental health coverage in your healthcare plan.
Ask for Your Complete Policy
Your complete policy will probably be a little different than the document you are given when you first secure coverage. As the name suggests, it is complete, meaning that it specifically details the scope of your care, including all of the treatments to that you are legally entitled.
Insurance companies and employers have been known to drag their feet when it comes to forking over complete policies. Don’t let them. It’s your legal right to see yours, and it will go a long way toward helping you understand where you are currently from a coverage perspective.
Get a Medical Necessity Letter
A medical necessity letter is a document from a doctor or therapist detailing how and why it is medically necessary for you to receive mental health care. Why is this important? Insurance providers are quick to dispute whether or not mental health treatment is “medically necessary.”
It’s unfortunate, but it’s also a pretty standard part of the process. Coming in with your medical necessity letter from the outset will help you cut through the red tape a little bit quicker.
Work Directly with Your Treatment Provider
Your treatment provider will often be the one who does the majority of dealings with the insurance provider. This takes much of the burden off your shoulders — the less time you can spend in this life communicating with insurance companies, the better — but it also leaves you out of the loop. A filed claim could turn into a dispute later down the road, leaving you slow to realize it.
Ask your treatment provider to notify you about any and all claims that they make. This will put you in a good position to anticipate and prepare for any potential upcoming issues.
Document Your Contact Encounters Carefully
Warning, this will get aggravating pretty quickly, and it might even make you feel like a difficult person, but it is an important part of the process. Here’s a sinister feature of dealing with any massive business: you almost never speak with the same person twice.
This means that when you call in with an issue, you are often left completely starting the conversation from scratch, making it very difficult to acquire any momentum. Documenting your encounters with the employees you speak to can help improve things.
Ask them to give you their ID number — they are required to do so on request — and then keep a careful record of what each person tells you. You’ll still have the challenge of bouncing around from person to person, but with your call log, it will be a little bit easier to develop continuity in your coverage conversations.
Understand where your responsibilities end and the clinics begin
While the insurance company will likely be all too pleased to argue with you about what is medically necessary, the majority of their most important objections will actually be more appropriate for the clinician to handle.
Again, it all comes down to what is “medically necessary”. You, at least from a legal/medical perspective, are not really qualified to determine that. Your treatment provider will be able to get much more traction handling medical-related inquiries. Pass all of that along to them and handle the nuts and bolts stuff yourself.
Understand the Insurance Claim Denials Process
There are many ways that insurance companies deny coverage. This includes things from “treatment wasn’t authorized,” to “maximum number of visits reached.” This latter issue is particularly common for mental health-related treatment.
Your clinician may recommend weekly (or even more frequent) treatments. However, if your insurance provider is only contractually obligated to issue a set number a year, this will be their often-sited, and in fact, most potent response to your requests.
Find Out What Your Rights Are
Isn’t that why we are here? Well, friend, there are limits to what sort of information you can get in one thousand words. And unfortunately, that probably wouldn’t even be enough to cover the introduction of a book titled “A State by State Guide to Healthcare Coverage Law.”
Oh, so you’re saying that it—
Changes state by state. Doesn’t everything? Some states will provide supplementary ways for you to receive mental health coverage. The federal government may also provide assistance options that extend beyond the scope of your traditional care.
It’s helpful to go into your conversations with a firm understanding of what these rights are, and how you can redeem them.
There is nothing fair about it. There shouldn’t be an uphill battle to secure the care that you need to live a healthy, happy life, but that is the way it is. It would be nice to say that one day you’ll reach the top of the hill and have a bright future absent of any resistance. Unfortunately, for many people, this is never the case.
Some like to leave dealings with the insurance company up to a trusted family member. This does give you a little bit more space to focus only on your own care, but it also leaves you out of the loop. You’ll have to decide for yourself what strategy is best.
In all cases, come to the conversation knowledgeable and prepared. It can go a long way toward helping you to get the care you need and deserve.