An insurance plan is a contract between the insurance company and the policy holder. Sometimes, the insurance company refuses to honor their portion of the contract however. When there is a mental breakdown, the treatment coverage can be questioned and the insurance company may refuse to make the payments. There are several ways to increase the likelihood that the mental health coverage will apply if the benefits are understood though.
Understanding the Facts about Insurance Coverage
Before beginning any treatment plan, it is crucial to review the health insurance policy and determine what is covered and what prior approval needs to be given before beginning a treatment plan. Contact the insurance company and ask what mental health coverage is included as well. If the situation precludes this, have a trusted friend, medical professional or employer help explain the information.
Previous Appeal Laws
In 2010, the Affordable Care Act made it easier to appeal health insurance coverage denials. Previously, the right to appeal a decision depended on the state of coverage, the type of health insurance and whether the health insurance was publicly or privately issued. Some states allowed experts that were not covered by the health plan to make decisions on coverage, while other states provided no right to appeal a decision.
Current Appeal Laws
Now when mental health care coverage is denied, the right to appeal is federally mandated. If a coverage decision is disputed, the health insurance company will have to review the decision. If after the review process, they still refuse to provide coverage, an independent reviewer who is not employed by the insurance company will have to determine if the claim falls under the policy plan. It is also possible to appeal a mental health coverage denial more than once if it fails the first time.
What Issues can you Appeal?
Under the new policies, mental health coverage can be appealed if the insurance company determines that the treatment plan is not medically necessary. It can also be appealed if it is found that the policy holder is not eligible for a particular benefit or if it is related to a pre-existing condition. In addition, any experimental care can be appealed for eligibility. In order to start the appeals process, it is important to keep records, get preapproval if possible and follow the proper channels required by the insurance company.
When Insurance Won’t Cover It
It is also important to take care of mental health in addition to physical health. Relax and find the time necessary to rejuvenate the mind and body. By spending time with friends and family, indulging in time doing things that bring enjoyment and helping others, it is possible to prevent a mental breakdown. Regardless of whether there is mental health coverage though, it is vital to seek medical help when it is warranted.
Work to stay healthy, physically and mentally. When that fails, it is possible to get mental health coverage by being proactive about what the policy plan includes. Even if a claim has been denied however, the decision can still be reversed and with the new Affordable Care Act of 2010, the appeals process is streamlined and universal.