Things to Know About Mental Health Coverage


Here are some things we have found as we have worked with clients that are submitting bills to their insurance company:

Often times the mental health coverage is not very different if the provider is in network or out-of-network. Your benefits package will show you the percent they will pay for either situation.

Out-of-network services sometimes must meet the same standard as if they were in-network to be covered. This means you must get preauthorization for certain services to count towards your deductible if when the provider is out-of-network. Check with your provider if they need preauthorization before your first appointment.

Some employers contract with EAP services. The EAP therapist will make an initial assessment to determine if 1) you need a specialist, 2) you would benefit from having therapy over a few months rather than a limited time. For example, Blomquist Hale is the biggest EAP in Utah. The employee can usually have 6 free visits then the EAP therapist will need to refer them out. So, if your employer does offer an EAP plan, you may benefit from talking to them about your options with them or with being referred to someone else.

There are times that the insurance company needs something from us that will increase your chances for reimbursement. They may have a form for us to complete to become a provider or an approved out-of-network provider. It’s good to ask them what they might need from us to help facilitate the process. It is helpful to explain to them why you are choosing to come to us, this can help them determine if they will reimburse you.

Keep in mind that once your insurance company has the information about your mental health it is no longer confidential. It will be in your records and, under certain circumstances, it can be reviewed by an outside source. Some individuals that have mental health coverage, choose to not use it to ensure the highest degree of confidentiality.

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