Understanding Billing And Insurance Coverage for Mental Health Services: Tips for Patients and Providers

Understanding Billing And Insurance Coverage for Mental Health Services- Tips for Patients and Providers

Mental health is just as essential as physical health, yet many people struggle to receive care owing to a lack of understanding of insurance and billing processes. This article will help patients and professionals understand mental health bills and insurance.

Understanding Insurance Coverage for Mental Health ServiceS

Let’s talk about the main laws and requirements for mental health insurance.

Mental Health Parity Laws

Insurance companies rarely cover mental health services in the US. Mental Health Parity Laws require insurance companies to cover mental health care at the same level as physical health services. These laws cover most insurance policies, including employer-sponsored and Healthcare Marketplace plans.

In-network vs. out-of-network providers

Understanding in-network and out-of-network mental health providers is crucial. In-network providers have a discount agreement with your insurance company. Out-of-network providers are not covered by your insurance company and may cost more.

Deductibles, copays, and coinsurance

Mental health services have deductibles, copays, and coinsurance like physical health services. The patient pays this portion of care. Insurance coverage begins with deductibles. Coinsurance is a proportion of the overall cost of care, while copays are a fixed monetary amount paid at each appointment.

Pre-authorization requirements

Certain mental health insurance plans demand pre-authorization. Inpatient hospitalization and intensive outpatient services require insurance company clearance. Coverage may be denied without pre-authorization.

Coverage for specific mental health services

Mental health insurance coverage varies by service. Some insurance cover psychotherapy more than pharmaceutical management, or vice versa. Know your plan’s coverage for your services.

Does Your Health Insurance Cover Mental Health

Health insurance is confusing. It might be hard for young people to find out what’s covered, especially mental health, when they’re on their own.

Despite federal rules requiring insurance companies to cover mental and physical health equally, significant discrepancies exist. 42% of people have trouble paying mental health bills. Even with school, parent, or job insurance, treatment beyond mindful meditation can be expensive.

During the COVID-19 pandemic, expensive mental health care has taken on additional urgency. Last year, nearly 80% of 18-to-24-year-olds and 75% of 25-34-year-olds who completed an anxiety or depression screen had moderate to severe symptoms.

20% of major depressives don’t seek treatment, and it’s easy to see why. Younger generations, particularly Millennials, are more inclined to go to therapy. Therapy copays range from a few dollars to $50 or more, even with insurance.

Waiting for insurance companies to organize isn’t an option for many. You may not wait. You can cut costs. As the CEO and co-founder of an HSA provider, here are some tips for finding affordable mental health care:

  • Consider your mental health provider needs (aka a therapist or psychologist). Your options may vary by location. Searching the provider’s reviews will help you choose the best one. Check out NAMI, the AMA, and the ABCT.
  • Check each provider’s website for health insurance acceptance. Most insurance carriers have online lists of in-network mental health doctors, or you can contact and request one.
  • Discuss a discount or payment plan with your out-of-pocket therapist. If they won’t, move to an in-network provider. Dealing with solely in-network therapists or psychiatrists may limit your options or take longer to find a good fit, but the long-term savings may be worth it.
  • Finally, avoid out-of-network practitioners at in-network hospitals or treatment centers. Health Affairs discovered that patients treated by out-of-network doctors (often unintentionally) at in-network hospitals spend $40 billion a year.

Tips for Patients

Check the most valuable tips for patients in the mental health domain.

Insurance Coverage

Before seeking mental health services, check your insurance coverage. To learn what services are covered and at what level, contact your insurance company or review your plan documents.

Mental Health Benefits

Mental health benefits should be understood along with coverage. This includes pre-authorization, deductibles, copays, and coinsurance.

Discuss Out-of-Pocket Costs

Don’t hesitate to ask about out-of-pocket costs. Copays, deductibles, and coinsurance are examples of this.

Network Considerations

In-network or out-of-network mental health providers should be considered when choosing one. Out-of-network providers charge more than in-network providers.

Understand Billing

Knowing the mental health billing services process can help you avoid surprises. Be sure to ask your provider how they bill and if they accept your insurance.

Tips for Providers

Here is what mental health providers needs to know. 

Verify Insurance Coverage

Before treating a patient, check their insurance coverage. This ensures that the patient is eligible for your services and that you will be reimbursed.

Obtain Pre-authorization When Necessary

Some mental health services must be pre-authorized by insurance plans. Understand your patients’ insurance plans and get pre-authorization to avoid denied claims.

Submit Accurate Billing Information

To process claims quickly and accurately, submit accurate billing information. Diagnose and procedure codes must be included.

Follow Up on Claims

To ensure claims are processed quickly, follow up. If processing errors or delays occur, contact the insurance company.

Provide Resources for Patients

Resources can help patients understand their insurance coverage and the billing process. Consider creating a handout or website with information about insurance coverage, billing practices, payment options, and financial assistance programs.

Treatments Health Insurance Can Cover

The mental health parity law covers mental and behavioral health services as essential health benefits.

Mental health, behavioral health, and substance use disorder services must be covered by plans. Depending on your state and health plan, these mental and behavioral health treatments may be covered.

Psychotherapy and counseling: “Talk therapy” can help patients deal with daily life, trauma, grief, and mental illnesses like depression and anxiety.

Psychiatric emergency services: Attempts at suicide, substance abuse, depression, psychosis, violence, and other sudden behavioral changes require immediate attention.

Telemedicine and online therapy: This therapy helps patients via phone or video chat without seeing a mental health professional.

Addiction treatment: Helps drug addicts quit. Cognitive-behavioral therapy and medication may be used.

Co-occurring medical and behavioral health conditions: Dual-diagnosis patients like those with addiction and depression.

Mental health billing FAQs

Hiring trained staff who understand mental health billing and insurance can help psychiatrists, psychologists, and therapists collect more. More patients and practice growth will offset the cost of hiring someone.

Mental health billing versus medical billing?

Therapists and counselors work very differently from other medical professionals. Patients and insurers are billed for medical procedures like x-rays and lab tests.

Patients and insurers are billed for therapy, medical management, and psychological testing in mental health. Insurers have limits on how long a session, how many per day or week, and how many treatments they’ll pay for. Mental health professionals must balance effective treatment with adequate reimbursement because the patient’s mental health needs may exceed the insurer’s.

How long are insurance reimbursements?

The insurer will usually pay your mental health practice 30 days after receiving a claim. Some insurers take two to three weeks, but most take 30 days.

Can clients pay the balance after insurance? Insurance-contracted mental health practices cannot balance bill. Accept the insurer’s rate and write off the balance. You can accept insurance reimbursement and bill the patient if you’re out of network.

Can I charge multiple sessions per day?

Most insurers enforce the one-session-per-client-per-day rule. Mental health practices may receive approval for multiple services per day. If the practice has a psychiatrist and counselor, the insurer may pay for both services. If the patient travels far and needs a longer session. Staying in touch with insurers and having good diplomatic skills will help.

While accepting $80 for a $150 service may hurt, insured customers are more likely to return than cash customers. Getting regular clients may be worth accepting lower reimbursement.

Can I charge multiple sessions per day?

Most insurers enforce the one-session-per-client-per-day rule. Mental health practices may receive approval for multiple services per day. If the practice has a psychiatrist and counselor, the insurer may pay for both services. If the patient travels far and needs a longer session. Staying in touch with insurers and having good diplomatic skills will help.

Outsource Mental Health Billing Services to Medcare MSO

Medcare MSO has been providing medical billing services for 11 years, so they are adept at addressing any problems that arise. Our mental health billing services are ISO-certified, speeding up your reimbursement from clients and insurers. We’ll handle all the paperwork, so you can relax and focus on more important things. Medcare MSO offers a wide range of mental health billing services, such as AR management, claim denial prevention, and more.

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