Navigating the mental health insurance process can be difficult from start to finish, but there are ways to make it easier, says Joe Feldman, president and founder of nonprofit organization Cover My Mental Health.
Difficulties can include finding a clinician and then getting the insurer to pay for the care.
The biggest and most immediate problem people experience is in finding a provider who is in their insurer’s network and also taking new patients, Feldman said. Sometimes, directories don’t list any providers who are available to the patient, he said.
Some who are able to find a clinician who is in-network may see coverage being denied because the insurer deemed it not medically necessary. There are ways to contest those decisions, but they are difficult to maneuver and favor the insurance company, Feldman said.
Feldman has some tips to make the process easier and more successful.
First, keep a record of the efforts you made to find a provider.
“Document your search for a provider to be able to demonstrate to an insurance company that you’ve tried to use the directory and it hasn’t worked,” he said.
Second, ask your clinician to keep a record of your care and why it’s needed.
“Another step that you can take is to have the clinician document that the care that they have determined is appropriate for you is what the insurance company should cover, and that comes in the form of a medical necessity letter,” he said. The provider should be familiar with that process, it’s a very specific type of communication.
If those two steps don’t work, then Feldman recommended the filing of a formal complaint, which is a process that identifies that the insurance company is not treating the claim properly, and underscores that the insurer needs to take another look at it.