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Navigating Insurance for Mental Health Treatment

When reviewing your insurance to see if mental health services are covered, you may not know where to start. And when you’re experiencing a mental health crisis, you may not have the ability or time to navigate your policy to see what type of treatment is allowed, what the coverage costs, what the potential out-of-pocket costs are, or who can provide your mental health care. Our staff at Ocean View can guide you through the steps needed to understand your coverage.

Understanding Your Health Insurance Benefits: A Guide to Coverage

You might wonder how to check your health policy to see what it covers, its limitations, or the deductible amount. We can help you navigate your policy with this step-by-step guide.

The first step to take is to review your policy documents. The Summary of Benefits and Coverage (SBC) page summarizes your policy, including mental health services. Check if “behavioral health” or “mental health services” are listed. These terms mean that the service is covered. Once you establish that mental health is covered, go through the page to see if outpatient, inpatient, partial hospitalization, and intensive outpatient programs are covered. From there, you will see the amount your insurance company pays and the required cost-sharing. Cost-sharing requirements include copayments, deductibles, or coinsurance. 

The Certificate of Coverage, or Evidence of Coverage, which is connected with Medicare plans, goes more in-depth than the SBC section. In this section, you will see how many sessions you are allowed, exclusions for specific treatments, and annual maximums. Understanding what types of treatment your policy covers is essential so you’re not left with unexpected out-of-pocket expenses. 

Another critical factor to note is if your policy requires treatment to be “medically necessary.” If so, you will need a licensed provider to document the need for treatment. Your policy may specify the providers covered. For example, your policy may allow psychologists, psychiatrists, or clinical social workers but not other therapists.

Perhaps you don’t feel comfortable talking with a stranger. You can visit your insurance provider’s website and check your policy’s coverage.

When you call Ocean View Psychiatric Hospital, an admission representative will ask you for your insurance information to verify what you need to qualify for care with us.

The Importance of Insurance Verification: Ensuring Access to Care

Verifying your insurance is like reviewing your online order before you hit confirm. Before you receive treatment, your doctor, therapist, or other healthcare provider verifies your insurance. They do this because your coverage can change even if you have the same insurance as your last visit. Checking your insurance ensures:

• Check to see if your policy is active. They check to see if your insurance is active or inactive and let them know if your care will be allowed. The safety of knowing your claim won’t be denied can help you rest while receiving care.
• Avoid unexpected bills. Verification of your insurance coverage tells providers and you if there are out-of-pocket expenses you will need to pay. Financial transparency avoids the stress of not knowing what is covered. You can feel safe and trust that you’ll receive the care you need without unexpected bills.
• Guarantees payment. Active insurance and service authorization are key to your healthcare provider’s payment. 

Having someone assist you in the verification process in a crisis alleviates stress. Also, when one of our admissions representatives is aiding you in the verification process, they can deal with potential issues like:

• Inaccurate information: There are times when your information has issues. For instance, you may accidentally give a misspelling or an outdated policy number.
• Policy changes: Providers may not know if your policy has addedor discontinued services. Verification clarifies what services are allowed.

Making Treatment Affordable: Exploring Your Options

Access to mental health treatment can be challenging if you can’t afford it. Sometimes, even if you have a health policy, the cost of care can be expensive. Before you think you can’t afford mental health care, find out how Ocean View is here for you.

Ocean View’s Commitment to Accessible Care

Your mental health care is essential. Our medical and therapeutic professionals practice cutting-edge care personalized to fit your unique needs. We are committed to providing the best treatment for your complex mental health needs. This is why we have trained admissions representatives available 24/7 to support you when you need our help.

Working With Insurance Providers: Streamlining the Process

Talking with someone about your mental health coverage can increase your stress or anxiety. However, you can find ways to reduce potential issues by using helpful ways to streamline the verification process. 

Suppose you want to verify your insurance coverage and benefits before a crisis occurs. Here are some tips to aid you:

• Gather your health care and other helpful information in one place. By consolidating your information, you decrease the stress of finding data before you talk with someone.
• Review your policy regularly to stay current. You can access your policy information online or with a customer service representative.
• Maintain communication with your health care provider and your insurance company. An open line of communication can reduce potential issues if you need crisis stabilization at Ocean View.

Don’t forget that our admissions representatives are also available if you need help with verification.

A Focus on Comprehensive Care: Maximizing Your Benefits

Comprehensive care includes taking care of the mind, body, and spiritual needs. At Ocean View Psychiatric Hospital, we encourage you to take a whole-person approach to your health. For this reason, while you are with us, we will guide you in learning techniques to increase your well-being. During your psychoeducation sessions, you can discuss how your treatment is building your coping skills and how you can continue using these skills once you transition from one level of care to another, go back to your regular therapist, or go home. A few of the tips to maximize your benefits are:

• Stay up-to-date with preventative care measures. Your insurance covers health screenings, immunizations, and annual checkups.
• Get to know your pharmacy benefits. Learn about your plan’s list of covered medications and what generic medications are available. Check if your plan has the option to use a mail-order pharmacy. Your plan may offer lower prices for a 90-day supply of medications through those pharmacies.
• Most insurance plans offer wellness programs, including gym memberships, stress management classes, and nutrition counseling. 
• Many plans also offer medication management.

Financial Assistance Options: Helping You Afford Treatment

Affordable mental health care may seem impossible. However, our admission representatives will help you find options to pay for your complex mental health needs. We offer flexible payment options to support your path to recovery. Other ways to help pay for your mental health care are:

Understanding Your Insurance Coverage for Treatment

Health insurance policies vary according to each health insurance company and your plan type. Understanding the types of health insurance plans can make a difference when selecting a health policy. You may not like going through your provider to receive a referral to medical or psychiatric services. One form of insurance may have better options than the other. However, knowing what type of insurance is best for you takes information about the different plans.

Types of Insurance Plans: HMOs, PPOs, and More

There are several types of health insurance plans available. Here is a list of the types of plans and the coverage they provide:

• Health Maintenance Organization: A plan that limits you to only in-network providers is an HMO. HMOs are an affordable option when considering health insurance policies. However, because of the in-network restrictions, your choices of healthcare providers are limited. HMO plans require you to talk with your primary care provider about coordinating your care. Your doctor will then give a referral so that you can see a specialist, such as a cardiologist.
  • If you have an emergency, your HMO may make an exception and cover some of your out-of-network expenses. When you contact Ocean View for crisis stabilization, the admissions representative you’re working with will contact your HMO to verify coverage.  
• Preferred Provider Organization: This plan is called a preferred provider (PPO) plan because it prefers you use the list of providers it provides. However, if you choose someone not on their list, they will still pay the amount they allow. A PPO is less restrictive but often has a higher monthly premium, higher deductibles, or out-of-pocket payments.
• Exclusive Provider Organization: When you purchase an exclusive provider organization plan, you are restricted to a list of providers that your health insurance plan covers exclusively. The EPO won’t cover the cost if you use a health provider that is not on the list.
• Point of Service: A point-of-service (POS) plan is similar to an HMO but isn’t as restrictive. The POS will allow you to seek out-of-network care in specific circumstances. However, like an HMO, you will need a referral for in-network care from specialists.

You can purchase an HMO, PPO, or other plan through:

• The Affordable Care Act’s (ACA) health insurance marketplace
• Your employer may offer healthcare coverage as part of its benefits package
• Purchasing a policy directly 

Mental Health Parity: Understanding Your Rights

When choosing an insurance policy, mental health treatment may not be the first thing you think about. However, health insurance that covers mental health is a vital part of your recovery journey. The Mental Health and Parity and Addiction Equity Act (MHPAEA) is a federal law that helps prevent health insurance companies that cover mental health or substance use disorder (MH/SUD) benefits from having less coverage than other types of care. Unfortunately, the MHPAEA didn’t require MH coverage. The Affordable Care Act built in protections for those with mental health disorders by requiring coverage of MH/SUD services. Why is this important to know? When you call Ocean View for help, you know you’re covered. 

Ocean View’s Insurance Verification Process

When you call Ocean View, we have admission representatives who can help you through the mental health care verification process. We understand you are in a crisis and have streamlined the process.

Step-by-Step Guide: How We Verify Your Insurance Benefits

Calling a psychiatric hospital for help can be overwhelming. You may need our admissions representatives’ warmth and kindness during the verification process. Our admissions representative will take your call and ask you some questions. They must know your name and insurance information to contact your health insurance company. 

Working With Our Admissions Team: Simplifying the Process

Once our admissions representative receives verification from your insurance provider, they will perform a brief assessment. Our expert staff will assist you with compassion and understanding as you go through the process. Please ask questions; we want you to have the information you need to feel comfortable with your choice to start your healing journey with Ocean View.

Our admissions are based on your needs for acute psychiatric care. If we feel your needs are best met elsewhere, we will assist you in finding your best match. Our team will provide referrals to care options that suit you better.

Ocean View: Your Partner in Recovery

When you enter Ocean View Psychiatric Hospital, you will receive compassionate care. Our goal is to give you the care you deserve and the support you need during your healing journey.

Our Experienced and Compassionate Team: Dedicated to Your Well-Being

You will receive compassionate care from our experienced, caring team. We believe it is essential for you to feel welcome when you’re with us. Throughout your healing journey, we aim to meet your expectations of acute psychiatric care and go beyond them. Our personalized treatment plans and life skills techniques will give you the help you need to stabilize.

Our Commitment to Accessible Care: Making Treatment a Reality

Mental health treatment can seem out of reach. Our warm and welcoming admissions representatives are here to help you heal. We will take you through the steps necessary to verify your insurance. Perhaps you don’t have insurance, or your coverage won’t cover all your treatment. Don’t worry. Ocean View has flexible payment options. Treatment for your mental health needs is as easy as picking up the phone.

Take the First Step: Verify Your Insurance Today

The first step to receiving mental health care is calling. We are available 24/7 to meet your needs for care and stabilization.

We’re here to help you!

Navigating your health insurance policy can be overwhelming, especially when attempting to verify your coverage. The admissions representatives at Ocean View can guide you through the process. Call (844) 562-1212.