What Insurance Covers
Please note that insurance for mental health is different from physical health coverage. The differences seem subtle and may affect you more strongly.
Medical insurance does not cover marital/family counseling because it is not a medical issue and therefore it is not medically necessary. Depression and anxiety are examples of what is covered by your insurance.
Some insurance companies require a referral to your counselor (Monroe Plan), others do not. Please check with your insurance first.
In the past, Don has heard that some counselors would sidestep this regulation about couples counseling and see a couple/family, but tell the insurance company they are seeing one person for depression. The insurance companies were very clear that this is considered insurance fraud. Thank you for not putting Boice Counseling in the position to have to tell you no.
The gray area is as follows:
Many people who are separating consider suicide, have thoughts about it or have fleeting thoughts of it. Of course, we recommend counseling and that is covered. In dealing with the depressive symptoms, the idea of marriage or relationship comes up and needs to be resolved. If this is done with an individual, not the couple, and the main focus is depression, not the relationship, then insurance has no problem paying for it. The spouse or partner is allowed to come in from time to time but not regularly.
Under this law, which took effect January 1, 2007, health insurance providers are required to provide comparable insurance coverage for mental illnesses (“parity”) as the policies provide for other medical care. This will allow adults and children with biologically-based mental illnesses to receive the same health care coverage benefits as those provided for other physical ailments.
In a calendar year, the coverage must include at least 30 days of active inpatient (hospital) care, and at least 20 days of active treatment in a facility operated by the State Office of Mental Health (OMH), a psychiatrist or psychologist licensed to practice in New York, or a university faculty practice corporation. The cost of any premiums and deductibles must be consistent with those imposed for other benefits available under the insurance policy.
Insurance coverage for businesses with 50 or more employees must include treatment for schizophrenia/psychotic disorders, major depression, obsessive compulsive disorders, bulimia, anorexia, serious cases of attention deficit disorders in children, disruptive disorders, or pervasive development disorders. In addition, children under 18 years of age are eligible for coverage if they have serious suicidal symptoms or other life-threatening self-destructive behaviors, significant psychotic symptoms, behavior causes by emotional disturbances that place the child at risk of causing personal injury or significant property damage, or behavior caused by emotional disturbances that place the child at substantial risk of removal from the household.
A group insurance purchaser with 50 or fewer employees, such as a small business, will be required to make the parity benefits coverage for mental health services available for purchase upon request. In addition, the law seeks to offset the additional costs that may be placed on such groups by directing the Superintendent of the State Insurance Department to develop and implement a plan to fully cover the costs for these small group insurance purchasers, which will be financed through the State General Fund.
Is your time or money really tight? If you are self-pay (do not use your insurance to pay for sessions) you have these options: