Treatment for mental illness is not covered by all insurance companies. Some health insurance plans have clauses for psychiatric care and drug and alcohol treatment. Even the conditions are not the same, many policies lump them in together. However, even if you don’t have coverage for mental illness treatment, seeking help may block you from getting your treatment covered by a future insurance plan as well.
Insurance companies can consider a mental illness as a pre-existing condition, and will deny payment for any services rendered in the future. With the high cost of prescription drugs used to treat mental illness, this can indeed become very pricey for the patient.
However, there are a few ways to beat the insurance company and get your treatment paid for.
1. Find a loophole. Scour your insurance policy and find out what defines a pre- existing condition. For many policies, a pre- existing condition is one that has received treatment in the past six months. If this is the case, talk it over with your doctor and see if you can work out a plan to keep your medications off the insurance company’s radar long enough to kick out your diagnoses from the pre-existing condition list. You may be able to taper your medication or switch to an herbal treatment for a few months. However, never attempt to alter your treatment on your own without first consulting your physician.
2. Argue your case. Call your insurance company and ask about your pre-existing condition. Find out everything you can about the company’s policy on pre-existing conditions and mental health coverage. If your case is borderline, consult an attorney to see if you have a valid case against the insurance company.
3. Consider community mental health services. Many communities offer lower-cost mental health services that are based on a sliding scale fee according to your income. While this may not be a valid way to get your insurance to pay for your mental health treatment, it can be a way to get the care you need at an affordable price.
4. Wait for Healthcare Reform to take effect in your area. Under the new healthcare reform act, insurance companies will no longer be allowed to deny coverage to an individual because of pre-existing conditions. However, it is unclear if the new laws will also limit an insurance company’s ability to deny payment for treatment for pre-existing conditions.
5. Talk to your doctor. One way to get around the pre-existing condition trap is to find out if your condition qualifies as a borderline diagnosis or if you may have multiple diagnoses. Your doctor may be able to submit a new diagnosis that will provide treatment and qualify for coverage under your health insurance policy.
Even if you think that you don’t have a mental illness diagnosis, but have taken or are taking medication for depression, anxiety, or a suspected mental illness, you might be surprised to know that your doctor has already given you a diagnosis that you aren’t aware of. In order to prescribe any medication, bill an insurance company, justify his treatment plan, and protect himself against liability, your physician must provide a diagnosis code to support his actions.
If you don’t know what your diagnoses are, call your physician’s office and ask. The nurse can either discuss your diagnoses with you over the phone or arrange to have copies of your medical records sent to you for your review.
Even if your mental illness is considered a pre-existing condition by your health insurance company, you still have options to help get the best are at affordable prices. Know your options and don’t settle for what the insurance company says is acceptable. You can fight to get the coverage you need, even if you have to switch to a different insurance company to get better coverage.
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