Mental health care is been an area of medicine that has been often ignored in the past by traditional health care plans. What changes is the Affordable Care Act making to the availability of mental health care? With tax season upon us, and many Americans feeling the first bite of the fines for not having coverage, here’s a look at how the Affordable Care Act (ACA) has changed mental health care availability:
Though it has been difficult in the past to get functional mental and behavioral health coverage under most insurance plans, marketplace plans have changed that practice. The ACA requires all marketplace plans and most individual and small employer plans, to provide mental health coverage in policies. Specifically, the coverage has been expanded to include mental health, substance use disorders, behavioral health issues, rehabilitative services and habilitative services.
In the past, it’s been difficult to find insurance without paying a very heavy premium, especially if you had a pre-existing condition. This practice often included mental and behavioral health conditions, even when the insurance plan didn’t offer much in coverage for treating these conditions or had limits based on whether the patient improved in a short amount of time.
Now, most plans are not allowed to deny coverage or charge higher premiums because of a pre-existing condition, including mental illness. Young adults are now allowed to remain on their parent’s coverage until the age of 26 which is a big benefit, when three-quarters of all mental and substance abuse conditions start by the age of 24.
Requires Comparable Services
The ACA now requires most health insurance plans to provide comparable benefits between medical and mental health services. Most health insurance plans are now required to cover preventive services, such as mental health screenings and behavioral assessments, at no additional cost. Parity protections have been put into place for marketplace plans, requiring similar coverage between, for example, medical or surgical coverage and mental or behavioral health coverage. In addition, there is no longer a waiting period for mental health services and, no lifetime or annual dollar limits on marketplace plans, eliminating the “improve or suffer” mentality of many pre-ACA health plans.
Whole Health Approach
Many states have chosen to opt out of expanding Medicaid coverage, while many others are trying different approaches to facilitating ACA requirements. One unique approach is using an organization to build teams of health care workers, including mental health professionals, to oversee a patient’s care. Referred to by a variety of names, these Accountable Care Organizations coordinate Medicaid patient’s care. In Oregon, the team is given a set amount per patient which encourages them to provide comprehensive whole-health solutions.
Please note, that state-funded insurance such as Medicare, Medicaid and SSI does not cover our services. To maintain the lowest rates for treatment with the highest quality of care, all of Pasadena Villa’s programs are primarily private payment.
The truth is that many private insurance companies do not cover treatment in residential mental health programs. However, we will work with you and your insurance company, on your behalf, to access any possible insurance reimbursement for our services.
Our Admissions Team will coordinate the verification of your benefits to see if you have mental health coverage available and if our services will be covered under your specific policy. Once it is determined that your policy will cover our services, we will coordinate the pre-certification of your benefits as well as ongoing concurrent reviews for continued coverage during the course of treatment. Our insurance staff and clinical team will work diligently to ensure all medical records clearly demonstrate medical necessity, which will significantly increase the likelihood of insurance coverage.
The Villa Orlando and Pasadena Villa’s Smoky Mountain Lodge are adult intensive psychiatric residential treatment centers for clients with serious mental illnesses. We also provide other individualized therapy programs, step-down residential programs, and less intensive mental health services, such as Community Residential Homes, Supportive Housing, Day Treatment Programs and Life Skills training. Pasadena Villa’s Outpatient Center in Raleigh, North Carolina offers partial hospitalization (PHP) and an intensive outpatient program (PHP). If you or someone you know may need mental health services, please complete our contact form or call us at 407-574-5190 for more information.