Know Your Rights: Mental Health Coverage

Does your insurance cover mental health services?
According to Covered California, when it comes to our well-being, mental health is just as important as physical health.

Know Your Rights
Struggling with a mental health condition can be extremely difficult. Remember that even if things feel out of your control, help is available and you can find the treatment you need. Both state and federal laws apply to health coverage for mental health and substance use disorders in California.

Your mental health is just as important as your physical health. That’s why federal law, under the Affordable Care Act (ACA), says that mental and behavioral health services are essential health benefits that must be covered. These include behavioral health treatment, like counseling and psychotherapy; inpatient mental and behavioral health services; and substance use disorder treatment. All ACA-compliant health plans cover nearly all mental disorders, as well as substance use disorders and treatment for alcohol and chemical dependency.

In addition, federal law requires certain protections for mental health and substance use disorder benefits to ensure they are covered in the same way as most medical and surgical services. This means that things like deductibles, limits to days or visits covered, or the way care is managed must be the same for mental health and substance use as they are for other medical benefits.

California law provides added security by requiring every health plan in the state to cover certain mental health conditions, including the following:4

Major depressive disorders
Autism or pervasive developmental disorder
Bipolar disorder
Panic disorder
Schizoaffective disorder
Obsessive-compulsive disorder
Anorexia nervosa
Bulimia nervosa
Serious emotional disturbances in children under age 18
These are all serious conditions that deserve immediate treatment. Care is available for everyone, and having a health plan makes that care even more affordable and accessible. A health plan must cover outpatient diagnosis and treatment, inpatient hospital services, partial hospitalization, diagnosis, outpatient services and prescription drugs (if your health plan covers prescriptions), with the same terms as any other medical condition.

Start Your Path to Treatment
If you are in need of care, you can start your path to treatment today. The sooner you have support, the sooner you can begin to heal. For some health plans, you can make an appointment directly with a mental health care provider, but for others, you may need a referral from your primary care physician or your health plan.

 Best Regards, Your Pacific Group Team

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