Health Insurance in Texas

A traumatic experience occurs or you’ve decided to pursue counseling for other personal reasons. If you have identified a need for counseling, you’ve probably wondered whether or not it will be covered by your individual plan. Here’s how you can learn more about what mental health counseling is covered as a part of your health insurance plan.

Getting more information

Reviewing all of your documentation for your individual plan can give you access to benefit information. There are usually detailed benefits provided in the coverage documentation about mental health coverage. Your human resources team can also go over your plan benefits in detail with you. Your human resources representative can also follow up with your insurance company to plan-specific information about therapy and counseling.

Important questions to ask about your coverage

Once you’ve received all of the basic information you need, you should then inquire about whether or not you need a referral before seeking medical treatment. If you get pre-authorized for a visit, the visit to the physician is covered. If your insurance companies covers visits, you should inquire about how many are covered to better control out-of-pocket expenses. Some policies may actually require you to get authorized for each visit. Your plan may only cover a certain amount of visits annually, so you may want to verify the amount before treatment begins. There may be a separate amount of visits permitted for medication management. Your plan may only reimburse you for services you seek within your network. Preauthorization, network restrictions and the allotted amount of visits permitted annually are key considerations if considering getting coverage for your plan.

What if I have a publicly funded plan?

If you have Medicaid or a Children’s Health Insurance Program plan, you can still be covered. All plans must satisfy certain parity requirements. The plan benefits may be different for adults and children. Children are typically provided with a range of counseling services while states are allowed to choose whether or not therapy, counseling, drug counseling, medication management and social work are covered under the plan.

By law, all plans must offer some sort of coverage for mental health services comparable to physical health insurance benefits provided in order to be fully compliant. Those who are covered in a small group health insurance plan and those covered in plan sold publicly in the marketplace must offer a certain level of benefits to meet parity restriction requirements.