Mental Health Care is Medically Necessary- 10 Tips to Lower Mental Health Costs

Mental Health Care has a huge range of care possibilities and little coverage options. Insurance often pays for services that are medically necessary in an emergency or when referred to specialists as medically necessary from a primary care physician.

Patients have to ensure that the doctors that treat them are part of their insurance network and if they are not, they have to be ready to pay a higher premium. There is even the possibility that they may not get reimbursed at all for care if the facility is not properly certified. Certification of the doctors and facility is often essential for coverage. Some facilities seek certification after the fact but that is never guaranteed to be accepted. 

The definition of care that is considered medically necessary when authorizing mental health care can be very subjective. Costs can range anywhere between $100 a day to 25K a day and more for different care centers. In-patient 24-hour care for mental health can be a huge cost to patients and their families if they are not informed about what their insurance covers and how they cover it. Here are 10 ways to save on Mental Health Care Coverage:

  1. A Mental Health Evaluation is covered in an emergency when a patient demonstrates that they are a danger to themselves or others and such is determined by a licensed practitioner in a professional setting.
  2. If it is possible to avoid an ambulance that can cut costs. However, if someone is experiencing a crisis, call your local mobile mental health organization to get an evaluation on-site and further direct assistance.  
  3. When going to a hospital or mental health facility, make sure that they are already in-network with a patient’s insurance company.  
  4. 24-hour surveillanced care may be covered if a doctor determines that the patient is a danger to themselves or others at the time and that there is a treatment that can be administered. The facility should seek approval for care immediately and inform the patient or their family. Be aware that patients over 18 may not be able to contact family right away after seeking care unless a privacy release is signed. Families are encouraged to keep active privacy release forms ready in case of an emergency and a family member is transferred between hospitals without notice.  
  5. The facility has to keep a record of the services that are administered and a line itemized bill for care, seek out the itemized bill from the provider, especially if the insurance is fighting coverage. 
  6. If a patient’s plan limits the number of therapeutic appointments the patient can receive, the provider must get future appointments authorized based on the medical need and advocate for their service.
  7. Mental health care often involves a medical team. Seek out facilities that look to manage care while taking all aspects of health into account. Often a social worker, therapist, psychologist, primary care physician and a range of other specialists may be needed to facilitate care. When the medical provider helps the patient to keep it organized it helps to show consistency in a care plan that can be approved by the insurance.
  8. Due to the cost differences between providers, if possible it is better to call offices and ask for their costs of care, it is also a good idea to ask when their first available appointment is for a new patient. 
  9. The faster a patient who is receiving 24-hour care at a mental health facility is able to connect with an out-patient practitioner on a regular basis, the faster the patient’s care plan can be changed.     
  10. Care facilities want someone to sign as the responsible party for the cost of care, the patient, if over 18, should be the sole signatory. Parents of patients who are suffering from mental health issues or even drug addiction recovery will often be asked to sign as the responsible party for a patient that is over the age of 18. Parents do not have to sign to cover the cost of care and do not have to be financially responsible for these costs. It is easier for the patient, who is over 18, to get help applying for state insurance to cover the costs of care. When independent the patient may even gain more assistance to start a disability claim, if the illness is likely to last over a year, and start applying for further independent long-term care. 

Bonus Tip: Patients and families of patients can seek out help from a medical insurance advocate like MedWise Insurance Advocacy to help them negotiate the cost of care and seek approval from insurance providers for coverage at an hourly rate.  

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