It’s one thing to go to the doctor if you have an illness or other immediate need for care and to have that visit covered by your health insurance policy. But some people also need to see a medical professional for issues such as mental illness, physical therapy, or other health concerns.
Not all insurance plans cover these treatments, and coverage can depend on the state, the carrier, and the specific plan design. However, you can work with your healthcare provider and your insurance agent to find the best health insurance policy to fit your needs.
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Coverage for mental health and substance abuse treatment
Most state laws require a certain amount of coverage for mental illness and substance abuse treatment, but there are discrepancies in the level of benefits provided when compared to the benefits offered for the treatment of a physical illness.
Insurance plans usually limit the number of visits within a given time frame, and co-payments and deductibles may apply to those visits. Inpatient and outpatient care for mental illness and substance abuse treatment are usually covered in some manner. Check your summary of coverage and benefits for the exact number of days of care covered and what, if any, co-pays you’ll need to contribute.
Coverage for physical therapy and short-term rehabilitation
If you find yourself in need of physical therapy or short-term rehabilitation, check your plan to determine how many days are covered for either inpatient or outpatient care. Be aware that these limits are often subject to your lifetime and are not per year. You’ll also want to check the admission charges and co-pay fees for which you will be responsible.
Coverage in and out of network
For all medical care, including mental health treatment and physical therapy, make sure to see if your providers are considered to be in or out of network. For a plan with out-of-network benefits, all treatment will be subject to your deductible and co-insurance for out-of-network physicians and facilities. But if your plan does not offer out-of-network benefits, then you will not have coverage unless you seek care from a participating provider or facility.
As always, talk to your insurance agent if you have any questions about your plan, and check in before you pursue treatment to make sure you’ll receive the coverage that you need.
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