Does Insurance Cover Therapy? What Affordable Options Are Available?

Are you one of the millions of people struggling with behavioral health issues? Now more than ever, people are struggling with mental health issues and substance use disorders. The isolation and fear of Covid have increased the need for an online psychiatrist. 

But, does your insurance cover therapy? Luckily most insurance plans offer some coverage for behavioral health issues. And, what if you don’t have insurance for therapy? There are resources to help find affordable coverage.

Employee Assistance Programs

Your employer may offer an Employee Assistance Program that offers some behavioral health benefits. Your employer pays for your EAP benefits. So, accessing your benefits are generally free and doesn’t have to be work-related. 

Even though EAP’s are a short-term solution, they help with the following:

  • Evaluation by a mental health professional
  • Initiate crisis intervention
  • Start short-term therapy
  • Provide referrals for further care

Although your EAP benefits can run out, they do renew each year. But, if your benefits have been exhausted and you still need treatment, there are options. For one, you can ask your employer if they offer discounted out-of-pocket rates for continuing behavioral health treatment. 

Existing Group Health Insurance Behavioral Health Benefits

Some health insurance policies don’t specifically list mental health coverage in the benefit summary. But, does health insurance cover psychologists? Often, you can look in the behavioral health section of your policy for coverage answers. 

Your employer may offer a choice of health insurance plans. If so, compare behavioral health coverage during enrollment periods. Although a plan may cost more, it may save you money vs. paying out-of-pocket. 

A Flexible Spending Account may be an option through your employer. This allows you to set aside pre-tax money for an online psychiatrist, psychotherapy, and prescription medication. Although it doesn’t lower the cost of treatment, it saves you money by not paying taxes on the money.

Marketplace Insurance for Therapy

When you purchase an insurance policy, the framework typically includes behavioral health insurance. In fact, health insurance purchased through the marketplace is mandated by the Affordable Care Act (ACA) to provide mental health and addiction benefits. 

Without the Affordable Care Act, insurance companies would sell plans without behavioral health coverage. If you qualify, the ACA may help you pay the premiums. The ACA helps individuals and families obtain health insurance who can’t afford it but make too much for state insurance.

If you have a mental health or substance use disorder, the ACA provides the following benefits.

  • Insurance companies can neither deny nor charge you more for coverage if you struggle with behavioral health disorders. Additionally, they can’t cancel your coverage when you are sick or using more services.
  • If you are 26 or under, you can be on your parent’s insurance policy. This applies even if you work and live elsewhere.
  • Insurance companies can no longer apply lifetime dollar or yearly limits on essential benefits. These benefits include mental health and substance use disorder treatment. 
  • Most health insurance plans must cover preventative services at no cost. These services include a depression screening for adults and behavioral health assessments for children.

Medicaid: Does Health Insurance Cover Psychologists?

If you meet specific criteria, you may qualify for Medicaid. Since Medicaid is state insurance, benefits will vary from state to state. However, some states do offer some insurance for therapy.

Medicaid covers more than just low-income people. The following groups may be eligible for Medicaid.

  • Pregnant women
  • Women with children under 6
  • Children ages 6-19
  • Supplemental Security Income recipients
  • Young adults up to age 21 who live alone
  • People over 65
  • People who are blind or deaf

Medicare: Does Insurance Cover Therapy?

If you are 65 and older, you may qualify for Medicare. Behavioral health benefits for inpatient treatment and outpatient services are provided through Medicare. Medicare Part D also includes coverage for prescription medication. 

However, if you have Medicare Advantage Plans check your plans for coverage details. These plans also have a Special Needs Plan if you have a significant mental health disorder. SNP’s offer expanded benefits for specific conditions, including mental health and substance use disorders. 

Disability Insurance for Therapy

Some mental illnesses can make it impossible to work. In this case, you may be eligible for disability benefits. For starters, disability benefits don’t automatically come with health insurance for therapy. However, after 2 years, you may qualify for Medicare and its services. For this reason, while waiting for Medicare benefits, you may be eligible for Medicaid. 

Does Health Insurance Cover Psychologists and Behavioral Health Treatment? 

Although insurance for therapy may only cover medically necessary treatments, the following services may be covered.

  • Emergency psychiatric services
  • Co-occurring mental health and substance use disorders
  • Psychotherapy and behavioral therapies
  • Unlimited outpatient therapy sessions with a therapist and online psychiatrist
  • Telemedicine and therapy with an online psychiatrist
  • Inpatient behavioral health treatment in a hospital or rehab setting
  • Addiction treatment
  • Medical detox programs including medications

Can Intensive Outpatient Programs Save You Money?

Generally, intensive outpatient programs (IOP) are more cost-effective than inpatient treatment. IOPs allow you to continue working and living at home while in treatment. If your insurance for therapy has high out-of-pocket expenses, this can be very beneficial.

Another benefit is some IOPs allow you to pay week to week. This is a better option for some as they don’t have extra money for treatment. If you are struggling to pay for or avoiding treatment because of money, it’s vital to speak to your doctor. There may be an alternative, more affordable options such as online psychiatrist.  

Why Is Telehealth and an Online Psychiatrist More Affordable?

Telehealth has been around for many years. However, once Covid struck, the need for telehealth services rose. If you were seeing a therapist for behavioral health issues, you may now see an online psychiatrist. One benefit to telehealth is the safety of social distancing and protecting yourself from Covid. 

Another benefit to talking with an online psychiatrist is the affordability. If you have insurance and use telemedicine to speak to your online psychiatrist, you may not have a co-pay for your visit. That can save a lot of money over time. 

If you are uninsured, the cost of telemedicine and an online psychiatrist is significantly reduced. A study in 2015 by the Boston Globe shows that waiting for s doctor’s visit costs a person $43. Telemedicine not only costs less per visit, but the money you save in travel time and time off work also saves even more. 

Does Insurance Cover Therapy and Medications?

Most insurance companies have a form of prescription coverage. However, there may still be high out-of-pocket expenses. If you can’t afford your medication, there are a variety of options to help. 

Some drug companies offer prescription assistance programs. They may require your doctor’s consent and proof of financial hardships. They may also require you not to have health or prescription coverage. 

Your doctor may also have free samples to give you. So, don’t be embarrassed and be honest with your doctor. You may be able to switch to a more affordable generic medicine. Or, your doctor may know how to get it cheaper. 

How Is the Covid Crisis Affecting Mental Health?

Because of Covid, more than 2 in 5 Americans are struggling with mental and behavioral health issues, according to the CDC. These issues include anxiety, depression, suicidal thoughts, and substance use disorder. 

“Markedly elevated prevalences of reported adverse mental and behavioral health conditions associated with the COVID-19 pandemic highlight the broad impact of the pandemic and the need to prevent and treat these conditions,” the report noted.

The stressors revolving around Covid can lead to Covid Stress Syndrome. 5 related aspects characterize this syndrome:

  • Danger and contamination fears
  • Socioeconomic concerns
  • Xenophobia
  • Traumatic stress
  • Compulsive checking and reassurance seeking

About 16 percent of adults struggle with severe Covid Stress Syndrome. The symptoms include:

  • Anxiety and depression
  • Panic buying/stockpiling
  • Self-isolation distress
  • Avoidance behaviors

What if You Need Help Understanding Insurance for Therapy?

If you’re like many others, understanding your insurance for therapy is like reading Greek. It makes no sense. But, there is help available to get your questions answered. 

If your insurance for therapy is through your employer, they may be able to answer the following questions:

  • Does insurance cover therapy?
  • Can I see an online psychiatrist?
  • Does health insurance cover psychologists?
  • How do I use my insurance for therapy?

If you have private insurance, contacting them can answer all your questions about insurance for therapy. Or, you can contact your state’s insurance department with questions. They can tell you if your insurance is following mandated benefits and help if you are having issues. 

Let Sana Lake Behavioral Wellness Center Help

Covid has many people feeling alone and struggling with mental and addiction issues. If you or someone you love needs help, we can help. Our compassionate representatives are waiting to answer all your insurance and treatment questions. Contact us today to find out how you can live Recovery for Life. 

References:

https://www.healthcare.gov/coverage/mental-health-substance-abuse-coverage/

https://www.psychiatry.org/patients-families/what-is-telepsychiatry

https://www.bostonglobe.com/metro/2015/10/05/study-puts-dollar-value-time-spent-waiting-for-doctor/If7KB4aU9mkY5qK8CqDYUO/story.html

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7361582/

https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress-anxiety.html

https://www.cdc.gov/mmwr/volumes/69/wr/mm6932a1.htm

What is ECT for Bipolar Disorder?

Bipolar Disorder is a mental illness that is very difficult to live with; pretending like the problem isn’t there is just as destructive as the illness itself. The most intimidating part of all of this is finding the right treatment option. For many, this includes electroconvulsive therapy.

What is Electroconvulsive Therapy?

Electroconvulsive therapy (ECT) is when electric currents move through the brain in order to encourage a brief seizure; this is intentional. This procedure is completed under general anesthesia which makes it very safe for the individual and as a result, it is mostly successful in causing changes in brain chemistry. The ultimate goal of this procedure is to reverse the symptoms of a mental illness, and in this case, bipolar disorder. 

ECT may not be tailor-fit for everybody that needs help with their bipolar disorder. There is no one-size-fits-all treatment plan for mental illness; it’s normal for some individuals to require more intensive treatment, and that doesn’t change any part of who they are as individuals. For those who require ECT, it works when other treatments have not.

The Stigma of Electroconvulsive Therapy

When it comes to ECT, there’s a bit of a stigma attached to it. Most of this has to do with the early treatments that have been done which administer high doses of electricity without anesthesia. Because of this, members in early treatments have experienced side effects such as memory loss, fractured bones, as well as many others. 

However, just because ECT has been known in the past to cause extreme side effects in its earliest of stages doesn’t mean that it hasn’t been worked on extensively to make it safer for those involved in the procedure. In recent years, ECT now uses electric currents in a more controlled setting in order to achieve the best results with the fewest amount of risks. 

Why is Electroconvulsive Therapy Done?

When it comes to electroconvulsive therapy (ECT), there are many reasons it is chosen to be used. ECT is often used to treat the following conditions:

  • Severe Depression
  • Psychosis
  • Treatment-Resistant Depression
  • Severe Mania
  • Bipolar Disorder
  • Catatonia
  • Dementia

There are some cases in which ECT is used as an option for treatment, particularly when therapy, medicine, or other forms of treatment won’t work. These cases include the following:

  • In the midst of a pregnancy where a developing fetus is in danger of harm from certain medications
  • When adults can’t tolerate the side-effects of certain drugs
  • Individuals that prefer ECT

The Risks of Electroconvulsive Therapy

Some alternative side-effects or dangers of electroconvulsive therapy (ECT) may include the following:

  • Confusion
  • Memory Loss
  • Nausea
  • Headaches
  • Jaw Pain
  • Muscle Aches
  • Medical complications

Those who experience confusion immediately following any sort of ECT treatment can experience this side-effect from just a few minutes to several hours. When this happens, an individual may not be too sure where they are or even why they’re presently in treatment.  

Sometimes this side-effect has been known to last a few days; in other cases, it has lasted longer. Very rarely, however, does this happen. It is worth noting that this confusion manifests itself as more obvious in older adults.  

When it comes to memory loss in ECT, some individuals who participate in treatment have a hard time remembering what happened immediately before their ECT. In some cases, members have forgotten events that may have happened weeks or months before. In other, much more rare cases, people will forget things from years before the procedure. This is what is referred to as retrograde amnesia. 

All of this is not to say, however, that these memory problems cannot improve after the treatment ends. In fact, many have been known to improve within a matter of months directly following their treatment. Other side effects such as nausea, headaches, jaw or muscle pain can be treated directly after treatment with medication in order to curb these side-effects. 

It is worth mentioning that any treatment for a condition that requires anesthesia will put a member at risk for some medical complications. For example, during electroconvulsive therapy, one’s heart rate and blood pressure will spike. This has been known to lead to heart problems for many. 

What to Expect in Electroconvulsive Therapy

Electroconvulsive therapy (ECT), much like any other form of treatment unknown to a particular individual, is scary. However, that doesn’t mean that there’s no way to be prepared. When it comes to what someone should expect from this form of therapy, there is firstly an evaluation process. This evaluation includes the following:

  • Evaluation of Medical History
  • Physical Exam
  • Psychiatric Assessment
  • Blood Tests
  • Electrocardiogram (ECG)
  • Risk Assessment

ECT can be done as in member or out member treatment. All in all, the procedure takes anywhere between five and ten minutes to complete, preparation and recovery excluded. Recovery and preparation are important parts of this process. 

Before the procedure, members are required to be put under general anesthesia. What this means for an individual beforehand is that they will be expected to restrict their diet. Usually, this means no food or water after midnight (however, a sip of water for medications beforehand is permissible). 

The physical exam that is taken before the treatment is used to assess the condition of one’s heart and lungs. This is an imperative part of the process because the heart and lungs are among the biggest risks when it comes to ECT. 

IV lines will be inserted into the member’s arms or hands so that medications and fluids can be given by a nurse or team member during the procedure. In addition to this, electrode pads will be placed on an individual’s head.

When the procedure begins, the anesthesia will be administered via IV to ensure that the member is unaware of the procedure and unconscious in the process. A muscle relaxant is also administered to minimize the risks of ECT. 

During an Electroconvulsive Therapy Procedure

During an electroconvulsive therapy (ECT) procedure, a blood pressure sleeve is placed on the ankle in order to stop the muscle relaxant from impacting the feet in any negative way. When the treatment commences, those administering the procedure can monitor seizure activity by watching for foot movement.   

Monitors are also used during the procedure to check one’s brain, heart, and blood pressure so that nothing terrible happens to an individual. Keeping an eye on each member is imperative in this process. There are other pieces of equipment such as mouth guards that ensure an individual doesn’t hurt any parts of their mouth, teeth, or tongue. Oxygen masks are also used in efforts to be sure that members are receiving enough oxygen during the procedure. 

Seizures in Electroconvulsive Therapy

While under general anesthesia, the doctor administering the procedure presses a button through the ECT machine so that the minimal electric current runs through the electrodes of the brain. This produces a seizure that lasts less than a minute. It is worth mentioning, however, that because of the muscle relaxant and anesthetics, one will remain unaware of the seizure that is being induced. 

Frequency of Treatment 

When it comes to electroconvulsive therapy (ECT), treatments are administered anywhere between two to three times per week for a period of up to four straight weeks. The total number of treatments round out at twelve. There is also a newer ECT technique that’s done on weekdays. This treatment is called Right Unilateral Ultrabrief Pulse Electroconvulsive Therapy. 

The number of procedures a person will undergo depends strictly upon their context and how much ECT they require. It is also dependent upon how successful the procedure has been for the member. Sometimes, individuals may be advised not to return to work, make important decisions, or drive a vehicle until up to two weeks following the treatment. Sometimes people can return to doing these tasks 24-hours afterward; it all depends on their threshold of success.

The Results of Electroconvulsive Therapy

Improvement from electroconvulsive therapy (ECT) is largely dependent on the individual and is thus examined on a case by case basis. Some individuals improve their symptoms after six treatments of ECT. For some individuals, improvement may take a bit longer. It is also worth mentioning that ECT may not work for everyone. 

In relation to depression and other mental illnesses, nobody has been 100 percent certain as to how ECT treats them. However, it is known that one’s chemical brain function is changed both during and directly following a seizure. These chemical changes can reduce severe mental illness by building upon each other. For this reason, ECT is most successful for those who complete it all the way through multiple procedures. 

ECT may not be the end all be all when it comes to treatment for mental illness. Sometimes, following an ECT procedure, individuals will still require treatment for their depression or other mental illnesses in order to prevent any sort of recurrence. Most often this includes taking antidepressants, counseling, or even more ECT with less frequency. 

Sana Lake is Here to Help

When it comes to treating those who suffer from severe mental illness, Sana Lake is sure to leave no stone left unturned. Our aim is ultimately to help members on an individual basis and treat them in a way that’s best for them. If you or a loved one are interested in finding out more, you can contact us here

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