Is it standard for health insurance policies to not cover any mental health services or medications?

Question

My boyfriend has depression and used to be on Zoloft. I feel he should be on it again however his health insurance plan does not cover mental health services. It seems to be a good plan, what it does cover it covers very well, so I'm surprised it will not cover this. Is this typical?

Answer 1

No its not-most reputable insurance plans cover mental health and prescriptions -sounds like he has a supplemental insurance plan and not Major Medical which he needs to have-unfortunately even if he changes this is a preexisting condition and more than likely will have a waiting period to cover it. He can get prescription card now-search under prescription help and similar topics and can get one for approx 90 some dollars a year or even less . His family doctor can prescribe Zoloft-any MD can.Tell him to go for family doctor will understand his situation if he doesn't any MD will/can prescribe and then shop for lowest price like at Costco. Hope I helped.

Answer 2

There is something called Mental Health Parity...not sure if it is just in CT or all thru the US. If you go to a psychaitrist (MD) that visit must be covered like any other doctor (but be sure you chose a network dr etc).

However, to get counseling for depression, you can see a PHd who might not be an MD. That may not be covered according to your plan. I have worked with a number of health plans and it is typical to see limits on the amount of mental health services (visits to counselors) that are paid (anywhere from 10-30 visits per year is what I've seen).

I have not seen the RX specifically targeted. Zoloft itself maybe targeted as a tier 3 drug or made very expensive by the plan. But there are many drugs available and many are become generic. I'd call the health insurance company and investigate further. Also, I'd see if there is an EAP (employee assistance program) that will help. Call the HR dept or the Benefits Dept and ask these questions.

Answer 3

Insurance is regulated at the state level. Therefore it varies from state to state. Many states mandate that the policy includes the coverage however companies may design a plan that does not meet the state mandates as long as they disclose to you that the plan does not meet the mandates. In Texas it is not uncommon for individual plans to exclude or limit coverage for mental health. This is primarily due to 2 reasons. 1-past experience of abuse. It is extremely easy for providers and patients to abuse this portion of a policy because it may be very subjective. 2- It is extremely difficult for actuaries to predict the risk of mental health issues. Attorney's often deal in grey areas, very few things are black and white. Engineers on the other hand don't deal in grey areas, everything is black or white. Actuaries are more like engineers than attorneys. If you have cancer the insurance company knows the treatment regimen and very little is subjective regarding when treatment should begin, end, or what the treatment should be. However mental health is much more subjective, when is someone cured, when should the treatment end, etc.

Answer 4

When you say "switch in employment" did you mean to another company sponsored plan? If so, that IS Group Coverage and not Individual. If you signed up for the coverage on the pretext of the booklet they had sent you, and were then told they provided you with the wrong information, that is "bait and switch" and I would sue in a heart beat. If it is individual insurance there should be some form of Buy Up coverage that would allow you to purchase Mental Health Coverage for an additional fee. However, Blue Cross is a multimillion dollar insurance agency and should not be making mistakes like sending out wrong booklets to their insureds. I would recommend switching carriers if you have the choice.

Answer 5

No, that's not a standard. I work for the largest employer in the U.S.A. Our health insurance was improved a couple of years ago, giving us mental health benefits the same as for physical health. This has set a standard that the rest of the industry should follow. It will take time, and there won't be 100% compliance until it's required by law.

Answer 6

Check again. He might need a referral to a shrink from his primary, and then it is covered. Or, his service might have an EAP (Employee Assistance Program) component that he could use for counseling. It's a separate thing from the health plan. Both plans should offer confidentiality so using the service should not get back to the employer.

Answer 7

most insurance has a limited cover of mental illness this usually varies if the cause of mental health problem was organic or in-organic. you may refer to the policy coverage on how these services can be covered this are stated.

Answer 8

It depends on the insurance company. I know if a company is "self insured" they do not have to cover it, or can pick only a minor percentage to cover (sad but true). Google the "Mental Health Parity Act". Basically it states that mental illness should be treated as any other illness, but as I said, his insurance may have an exemption. IMHO, US health insurance is grossly lacking in many aspects. Unless you are fortunate enough to work someplace that provides it for you, or pays a percentage for you or, you are indigent and qualify for medicaid, you are left in the group of uninsured or underinsured.

Thanks for letting me vent on the sorry state of Health Insurance coverage for our citizens.

Answer 9

Blue Cross covers some. But most mental health services are covered poorly, if at all.

Answer 10

Insurance policies vary greatly. You should always find out exactly what the policy covers or does not cover prior to investing in it.

You may also want to consider a medical flex account for these unexpected types of expenses.