Arlen Lopiccalo: You have to check with the specific insurance company as to what mental health benefits their plans offer. Someone with a Masters degree is not a medical doctor but some types of therapy is covered. You have to see what insurance coverage is when you look for a plan.
Tricia Dossous: You'll want to ask an agent that works with all of the major companies in your area. All compliant health insurance plans sold in 2014, either on or off of the exchange, will have mental health coverage but it is limited. A therapist is not considered a specialist, and depending on the type of therapy may not be covered.In general, mental health is covered but with these exclusions:- Treatment for chronic or organic conditions, including Alzheimer's, dementia or delirium- Ongoing treatment for mental disorders that are long-term or chronic in nature for which there is little or no reasonable expectation for improvement. These disorders include mental retardation, persona! lity disorders, and organic brain disease.- Counseling, testing, evaluation, treatment or other services in connection with learning disorders and/or disabilities, disruptive behavior disorders, conduct disorders, eating disorders, psychosexual disorders or transsexualism, motor skill disorders, communication disorders, attention deficit disorders- Psychological testing or evaluation specifically for ability, aptitude, intelligence, interest or competency- Psychiatric evaluation, therapy, counseling or other services in connection with child custody, parole and/or probation, and other court-ordered related issues- Treatment in a residential treatment center except when voluntary or court-ordered for chemical and alcohol dependency- Therapy, counseling or other services related to relationship and/or communication issues - Counseling for educational, social, occupational, religious, other maladjustments, marital counseling, behavior modification, biofeedback, or rest cures a! s treatment for mental disorders- Sensitivity or stress-manage! ment training, self-help training, and/or residential treatment except as covered with chemical or alcohol dependency- Applied Behavioral Health therapy that includes sensory integration, LOVAAS therapy and music therapy- Psychiatric or psychological examinations, testing and/or other services in connection with obtaining or maintaining employment, insurance, type of license, medical research and competency issues- Behavioral treatment or drug therapy for sexual dysfunction and sexual function disorders regardless of whether the cause of dysfunction is due to physical or psychological reasons...Show more
Warren Kotter: Question- I am an agent in SC that has worked on group employee benefits for 20+ years, however a good friend asked me to help them get an individual policy for their 15 yr old daughter and it has been quite a challenge. The scenario is that my friend's husband's employer dissolved and only provides 1 month of COBRA coverage ending 8-31-14 so they fal! l under the special enrollment provision. They have a 15 yr old daughter that has been in outpatient treatment for eating disorder, severe depression, oppositional defiance, etc. however she needed to be admitted inpatient 8-1-14 so she is currently in an eating disorder facility that treats multiple DX.. I have been trying to find an individual policy that will cover her inpatient stay should she extend past the end of her COBRA term date. The closest I found is the Blue Essentials Gold 1 plan which indicates that it coveres mental nervous both inpatient and outpatient. Prior to having the family apply for the plan, I printed off the plan summary, product brochure and had the carrier send me a copy of the actual contract. My intent was to see if there are any exclusions related to eating disorders. I found one exclusion that indicated "services for feeding and eating disorders in a small child or infant is excluded" There was noting to define "small child". In addition,! there is no exclusion that excludes eating disorders outright. There i! s no exclusion that indicates "if not specifically listed as covered it is excluded" I have contacted the carrier on mumerous occassions and 50% of the CS reps indicate that since the patient is 15 the exclusion would not apply to her and benefits will be covered, . The other 50% say no its not covered based on that exclusion as stated above related to "small child or infant". I have argued that that exclusion does not refer to a teen or adjult and I have asked them for somthing in writing that specifically excludes eating disorders for teens and adults. They said they did not have anything that specifically excludes the treatment but "that is how it is administered". They said they will have a supervisor contact me in 48 hours. Since then I spoke with a direct sales agent for BCBS marketplace that contacted the claims depatrment supervisor to see if the claim would be covered or not and they indicated "covered". In researching further there is so much conflicting informat! ion out there related mental health I am thinking this is a legislation issue with mental health parity and updates, ACA plans that differ by state, the state superseding federal, the definition of mental nervous, what is excluded and what is covered under mental nervous, the ability for the carrier to administer the plan at their discretion without having a contract to support how they administer it. Any guidance on how SC handles this type of benefit that would be appreciated. How dual diagnosis is handled, etc. Thank you in advance for help!...Show more
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