What Is Behavioral Health and Am I Covered?

Lucy Lazarony
November 20, 2020

Behavioral health describes the connection between behaviors and the health and well being of a patient’s body, mind and spirit. Behavioral health includes how behaviors such as eating habits, drinking or exercising will impact a patient’s physical and mental health. As for treatments, behavioral health refers to mental health, psychiatric health, marriage and family counseling and addiction treatments.

Behavioral health includes services from social workers, counselors, psychiatrists, neurologists and physicians. What’s the difference between behavioral health and mental health? Behavioral health includes mental health by its very definition. Behavioral health looks at how behaviors impact a patient’s mental and physical health. Are behavioral health services covered by health insurance? Yes, they are.

Since the enactment of the Affordable Care Act (ACA) in 2014, most individual and small group health insurance plans are required to cover mental and behavioral health and substance use disorders, according to the U.S. Department of Health and Human Services. Considered an essential health benefit, mental and behavioral health services must cover behavioral health treatments such as psychotherapy and counseling, mental and behavioral health inpatient hospital services, substance use disorder treatment and any pre-existing mental and behavioral health conditions. Employer plans are required to comply with ACA requirements for mental and behavioral health. So if you are going from an individual plan to an employer plan, your behavior health services will be covered.

Your Behavior Health Benefits

Could you benefit from some behavioral health counseling? Don’t be afraid to reach out for help. Need assistance paying for the counseling? Your insurance can help. Will your insurance cover a half dozen of counseling sessions for you? What is your co-payment per session? It is important to find a counselor you like. So if you don’t click with the first counselor you meet, don’t be afraid to try another one. Behavioral health counseling is all about openness, you want to find a counselor that you trust.

Pay Your Deductible

Don’t forget about your deductible. Unless you have an HMO, your deductible is the amount you need to pay before your insurance company begins to make payments for health services. So you may need to meet your deductible before you get help from your insurance company for your counseling sessions. Be sure to check to see what you’re responsible to pay. If you’ve had other health services, you may have already met your plan’s deductible. So you’ll get help from your insurance company straight away for your behavioral health services.

Out-of-Network Benefits

If you found a counselor that you like who doesn’t take your insurance, find out if your health plan covers out-of-network providers. There may be a higher cost than with an in-network provider but it is still less expensive than paying for the full price of the visit out of your own pocket. Sessions could run $75 to $100 per session depending on the city or part of the country where you live. For an out-of-network provider, you’ll need to pay out of your own pocket upfront. You’ll then file monthly claims to your insurance company to be reimbursed for a portion of the cost of the counseling sessions. How much you’ll get reimbursed varies from insurance plan to insurance plan. Reach out to your insurance company for details.

Choose In-Network Providers

When you begin searching for a counselor, begin with the list of in-network providers from your insurance company. These are among the most-cost effective counseling options you can find. You’ll pay less when you stick with in-network providers who already have a relationship with your insurance company. With the cost of sessions being so high without the help of health insurance, it makes sense to start here in your hunt for the right counselor for you. You’ll pay less for your sessions and you may just find an in-network counselor that you really like.

Sliding Scale Prices

Counselors who do not take insurance often offer a sliding scale price for their services. This means they are willing to take less of a payment from patients who couldn’t otherwise afford to be there. Review your finances and decide on an amount per session that you are willing to pay. Share this number with the counselor. If all goes well, you’ve just signed up for counseling sessions at a reduced, sliding scale rate.

Student Counseling Benefits

College students may be eligible for counseling sessions for free. Check to see the behavioral health services available on campus. For example, a college student may be able to see a therapist twice a month for a total of 10 sessions, free of charge. And once the student reaches the 10 free sessions, he or she will be referred to a professional counselor in the area. Feeling stressed on campus? Don’t hesitate to reach out for free counseling sessions.

Check Out Community Mental Health Clinics

Looking for an affordable mental health treatment center? Community mental health clinics typically have lower fees and accept all types of insurance. At a community mental health clinic, you may be matched with a mental health intern, who under supervision, will provide therapy at a reduced rate or even free of charge.

Try Group Therapy

If you are comfortable sharing your story with others, you might want to join a group therapy session. The price for group therapy is much lower than with individual sessions. And you may learn something new and interesting from other members of the group.

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