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No. 26 (Updated 2/14/2013)


Insurance benefits for mental health services have changed a lot in recent years. These changes are consistent with the nationwide trend to control the expense of health care. Here are some useful questions to ask when evaluating the mental health benefits of an insurance plan.

  • Do I have to get a referral from my child's primary care physician

  • Is there a "preferred list of providers" or "in network providers" that he/she must see?

  • Are child psychiatrists included?

  • Is there an annual deductible that I pay before the plan pays? How much is my copay per visit? What services are paid for by the plan: office visits, medication, respite care, day hospital, inpatient?

  • How many sessions are permitted?

  • What can I do if I am unhappy with either the provider of the care or the recommendations of the "utilization review" process?

  • What hospitals can be used under the plan?

  • Does the plan exclude certain diagnoses or pre-existing conditions?

  • Is there a "lifetime dollar limit" or an "annual limit" for mental health coverage, and what is it?

  • Are there other terms, conditions or limitation to coverage?

Most health care insurance offers a “Mental Health Manage Care” plan. Managed Care is intended to reduce the cost and improve the quality of care covered by health care insurance. The insurance company will decide who can provide health care services, limit when the services are provided and determining if the services provided were medically necessary. Make sure you insurance will cover the service to be provided. Most insurance plans will not cover services not medically necessary.

For more information regarding your rights for mental health care through your insurance provider go to:

Additional/related Facts for Families:
#00 Definition of a Child and Adolescent Psychiatrist
#24 Know When to Seek Help for Your Child
#25 Know Where to Seek Help for Your Child
#52 Comprehensive Psychiatric Evaluation and
#75 Advocating for Your Child.
For additional information see Your Child (1998 Harper Collins)/Your Adolescent (1999 Harper Collins).

This article was written by Becky Ohde, a staff member.

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