101. Does health insurance cover the cost of psychological treatment?

The simple answer is yes, at least in part. Health insurance plans typically cover medically necessary treatment for emotional problems.  However, some plans, especially managed care plans, may narrowly define what is “medically necessary.”  Most of the time, depression, anxiety problems, and other common mental health issues are covered by health insurance.

But, there are times when your insurance company may hesitate to cover mental health treatment. If psychological treatment is mandated for legal reasons, such as domestic violence, or because of an offense that includes probation, your insurance may claim that the treatment is not medically necessary, only legally necessary. Also, some plans do not cover couple counseling, and others try to avoid paying for family treatment. 

Most troubling, is when an insurance plan tries to limit treatment by suggesting that you have reached your “maximum benefit” from the treatment. This is a way of saying that you still have problems usually treated, but the insurance company does not feel that further treatment will be helpful. Imagine how people would react if we did this with cancer treatment! Suppose someone is deemed terminal, and the insurance company said, treatment will not help, so we will not authorize any further treatment.

Certainly some treatment is designed to prevent pain, or to slow the course of an illness, even if it cannot be successfully treated. But with mental health problems, insurance companies manage to get away with limiting this type of treatment, and, because of broad social prejudice concerning emotional problems, they get away with it.

 

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