Health Insurance Coverage and Mental Illness

Individual or Family Health
Group Health Coverage

Health Insurance Coverage for Mental Illness

Mental Illness affects millions of American families. And whether forced to deal with the sometimes devastating emotional problems that occur with Clinical Depression, Bi-polar Disorder, or any of a number of other conditions - the stress and strain put upon a family dealing with mental illness is made that much worse when treatment is available - but may not be covered by your family health insurance policy. 

There is no standard requirement that health insurance policies provide provisions for mental health or substance abuse treatments or therapies. What services are covered vary from State to State, and from insurance company to insurance company, policy to policy - so your best bet when facing the need for mental health treatments for yourself or a family member is to check with your insurance agent or your companies benefits advisor to make sure exactly what if any provision there are in your health benefits for mental health treatments. Many companies offer their employees outreach service that are separate form their medical benefits. Such Employee Assistance Programs or EAP's are often limited to only a certain amount of visits or treatments, and may require referral by a physician, but still they provide some treatments at no cost. If you have exhausted those sessions and you do not have any other health insurance that covers treatments for mental or emotional illnesses, many States offer treatments through State mental health facilities on a sliding - or what you can afford to pay basis. You can check with your States Mental Health Services Agency or Department of Children and Families for the availability of such treatment facilities. And of course many churches, synagogues and other faith based institutions offer such family counseling services as well.

In 1996 the Congress passed the Mental Health Parity Act. While it does not require that an insurance company provide heath benefits for mental health services, it does require that if a company does provide such medical coverage that it must be equivalent in dollar amount to coverage for other medical/surgical services. However some States like New York have recently done the law one better by making such a requirement. Known as "Timothy's Law" named for a teen who committed suicide who could not get adequate treatment due to his parents lack of health insurance coverage - the law was one of the final pieces of legislation signed by former Governor George Pataki, before leaving office last year. The law mandates that insurance companies provide medical coverage for most mental illnesses. Timothy's Law stipulates that insurance companies must cover at least 20 outpatient visits and 30 inpatient visits per year for treatment of recognized mental disorders such as schizophrenia, clinical depression, attention-deficit disorder and certain eating disorders. The law falls a little short in that it does not currently cover alcohol or drug dependency treatments or treatments for Post Traumatic Stress disorder, but supporters hope that these will be added overtime.

Tom and Donna O'Clair, Timothy's parents were forced to give up custody of him so that he could qualify for state-funded mental health treatments, yet he took his own life at the age of twelve. Ever since they have fought to see legislation passed that would require heath insurance companies provide coverage for mental as well as physical illnesses - they were present when then Governor Pataki signed the bill into law last December.