Starting mental health care can feel daunting, especially when trying to understand insurance coverage and the financial considerations involved. Mental health is essential to overall well-being, yet many face challenges like confusing coverage, costs, and the stigma surrounding care. Our goal is to help you demystify the process and show you how to make sense of your insurance benefits so you can confidently take the first step toward the mental health care you deserve.
Your Benefits Likely Cover Behavioral Health—Plus, Your Company May Have an EAP Program
Your health insurance likely covers behavioral health directly through your health plan or via an outsourced vendor. “A quick review of your benefit summary on the plan’s website or a call to customer service will get you the answer,” according to Aaron Simon, Head of Managed Care at Geode Health. “You will likely be surprised that the co-pays and co-insurance look very similar to your health benefits.”
In addition, many people are unaware that their employer may offer mental health benefits through Employee Assistance Programs (EAPs), which can provide an important first step toward seeking care. These programs are separate from the company’s health benefits and often provide free, confidential counseling services and referrals to mental health professionals. Yet, studies show that a significant portion of employees do not take advantage of these resources. A 2021 survey by the Employee Assistance Professional Association (EAPA) found that nearly 40% of employees did not know their company offered an EAP, and only 10-20% took advantage of it. This lack of awareness can prevent individuals from accessing the support they need, even when available at no extra cost. Understanding and utilizing these programs can be a powerful way to begin your mental health journey without the financial burden or uncertainty that often comes with insurance benefits.
Simon adds, “To identify if your company has an EAP program, check your employee benefit summaries or call the HR department. Most EAP programs cover a limited number of visits, 3-10, and typically only include therapy, not psychiatry. Either way, it is a way to get started if you need help. Once the EAP benefits run out, you can typically continue seeing the same provider under your health plan benefits.”
Understanding your insurance benefits—such as copays, deductibles, and coverage for mental health services—ensures continued access to the care you need.
Many Plans Do Not Require Mental Health Referrals
A common misconception is that you need a referral from your primary care doctor before seeing a mental health provider. Still, many insurance plans allow you to see a therapist or psychiatrist directly without any referral. This can save you valuable time and get you started on the path to care much faster. However, it’s essential to check the specifics of your plan, as coverage can vary depending on where you live and the type of insurance you have. Some plans may have different rules for in-network versus out-of-network providers, or specific regions may have unique requirements. Don’t hesitate to reach out to your insurance company’s customer service team—they can clarify what your plan allows and guide you through the process. In addition, most insurance plans now cover virtual therapy the same way they cover in-person visits, so you may even have the option to get care online, making access even easier and more convenient. Understanding these details can help you skip unnecessary steps and get the help you need without delay.
Strategies for Maximizing Your Mental Health Benefits
Understand Your Plan
To make the most of your mental health benefits, it’s crucial to understand the details of your insurance plan. Take the time to carefully review your plan, paying special attention to mental health-specific coverage, such as therapy, psychiatric care, and telehealth services. Many plans include these benefits, but the level of coverage can vary, so it’s important to know what’s included.
In-Network vs. Out-of-Network Providers
Additionally, understanding whether a provider is in-network or out-of-network can significantly impact your out-of-pocket costs. In-network providers generally cost less, and insurance may cover a more sizable portion of the bill. If you choose to see an out-of-network provider, you might still be able to get reimbursed, but the process can be more complicated, and you may pay higher fees upfront. Knowing these details—and whether your plan requires pre-authorization for mental health services—will help you avoid surprises and make the process of seeking care much smoother.
Dealing with High Deductibles or High Copays
High deductibles and copays can make accessing mental health care difficult, but there are strategies to manage these costs. Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) are two options that can help you offset expenses for therapy, psychiatric care, and medications.
Health Savings Accounts (HSAs)
HSAs allow you to save pre-tax dollars for medical expenses, including mental health services. These funds are typically tax-free when used for qualified expenses, making them a valuable tool for managing high-deductible health plans (HDHPs).
Tips for Using Your HSA:
- Contribute early to ensure you have enough funds for the year.
- Track eligible expenses, like therapy sessions and medications, to ensure proper use of funds.
Flexible Spending Accounts (FSAs)
FSAs also allow you to set aside pre-tax money for healthcare, but keep in mind they may have a “use-it-or-lose-it” policy. FSAs can be a great option for covering mental health services throughout the year, either in addition to or instead of an HSA, depending on your employer’s offerings.
Where to Look Beyond Insurance for Mental Health Support
If using insurance for mental health care is not an option for you, don’t worry—there are still plenty of resources available to help! Consider exploring these options:
• Community-Based Resources: Local non-profits and clinics offer sliding-scale or free mental health services. Check your city or county website for available programs.
• Support Groups and Online Resources: Peer support groups and online therapy platforms can offer affordable, accessible options for care.
• Faith-Based Organizations: Many religious institutions provide counseling services or can connect you with professionals offering discounted rates.
These resources can be invaluable when insurance isn’t an option and can support you on your path toward better mental health.
Empower Yourself to Seek the Care You Deserve
Taking the first step toward mental health care can be as simple as calling your insurance company or HR to explore your EAP benefits. Start small—any step, no matter how minor it feels, is progress toward a healthier future. Understanding your options is key to unlocking the care you deserve; even the smallest action today can set you on the path to better mental health.
At Geode Health, we are here for you! Start your mental health journey at book.geodehealth.com.
