Available Options for Mental Health Insurance in Los Angeles

Available Options for Mental Health Insurance in Los Angeles

Mental Health Insurance Los Angeles: Everything You Need To Know

Deciding to seek treatment for a mental health issue can feel stressful, but in many cases, some of the costs may be alleviated by your health insurance. Thanks to the Mental Health Parity and Addiction Equity Act of 2008, most health insurers must make their mental health insurance Los Angeles benefits comparable to those provided for other conditions, giving psychological issues the same level of care as they would to medical and surgical procedures. 

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There are many choices out there when it comes to mental health insurance. Los Angeles residents can choose between the following:

  1. Health Maintenance Organizations (HMOs): HMOs are health insurance plans that usually require referrals to see a specialist, and you must get your care from within your insurance network or it won’t be covered unless it’s a medical emergency. 
  2. Preferred Provider Organizations (PPOs): A PPO plan doesn’t always require a referral from your primary care provider and you can get care from a provider outside of your insurance network. Out-of-network services will be covered at a smaller percentage than if you went with someone from within the network.
  3. Exclusive Provider Organizations (EPOs): EPOs allow you to see any specialist you wish without a referral, but they must be in your network. Out-of-network care is not covered at all unless it’s emergency care. 
  4. Managed Care Plan: A managed care plan is the most affordable of the insurance plans, but is also the strictest, as you must receive all medical care, referrals, prescriptions, etc. from a short list of approved places
  5. Point of Service Plan (POS): POS is similar to an HMO, but POS plan members may not need to get referrals from their primary care physician to see a specialist, as long as they’re also in-network

These plans will usually cover outpatient care, partial hospitalization, emergency care, prescription drugs, outpatient mental health treatment, and rehabilitation services. 

If you can’t afford insurance, or if your employer doesn’t offer an insurance benefits plan, some alternative mental health insurance Los Angeles care options may include: 

  1. Medicaid: Medicaid provides health insurance to low-income children and adults who meet certain eligibility criteria. Medicaid may cover outpatient and outpatient service, non-emergency transportation, case management, peer support services, psychiatric rehabilitation, crisis intervention, prescription drugs, and long-term care. Some plans also offer in-home and family support services and more.
  2. Medicare: People aged 65 or older and adults with disabilities may qualify for medicare coverage, which may include 190 days of outpatient services with licensed mental health professionals, emergency care, and prescription medications.
  3. TRICARE and VA Health Care: If you or your spouse served in the military you may be eligible for these federally run health insurance plans. Veterans may not have to pay copays for conditions like PTSD that may be related to combat service. TRICARE plans cover 30-45 days of outpathttps://momentofclarity.com/ient hospitalization per year, up to 60 days of partial hospitalization, and outpatient mental health services, emergency care, and prescription medications. VA Health care covers inpatient hospitalization and residential psychiatric rehab, outpatient mental health insurance Los Angeles treatments, psychosocial rehabilitation services, intensive case management, supported employment, emergency care, and prescription medication coverage.

Some Important Insurance Terms to Understand:

  • Network – an insurance network is a group of doctors and medical facilities that have signed an agreement with the insurance company to provide care at a specified rate. Out-of-network providers do not have this agreement with your insurance company. A network may include doctors, hospitals, pharmacies, and other medical service providers
  • Primary care physician – you must choose a “primary” doctor or general practitioner under many managed care plans. This is the doctor you will have to see for most health concerns that don’t require urgent care and the person who will give referrals to specialists when necessary
  • Specialist – any health care practitioner who specializes in certain conditions, like psychologists, psychiatrists, therapists, clinical social workers, and mental health nurses
  • Referrals – an official recommendation by your doctor to see a specialist or another health care professional
  • Premiums – the monthly payment amount it costs to receive insurance coverage 
  • Copayment (co-pay) – the dollar amount you pay out-of-pocket each time you get treatment or pay for a prescription
  • Deductible – the amount you have to pay before your insurance kicks in
  • Pre-approval – the insurance company agrees to pay for treatment before it begins
  • Cap – the final amount insurance will pay per year, or per lifetime, for your treatments

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Los Angeles Insurance Options for Mental Health Services

To find out what kinds of mental health insurance Los Angeles coverage your insurance plan offers, you can:

  • Call your insurance provider to ask what is covered, what the requirements are, how much the copays and deductibles are, etc.
  • Log in to your online insurance account and read the policy yourself
  • Ask your company’s HR department if you have insurance through your workplace
  • Check with the mental health treatment center. You can call Moment of Clarity and we can check your coverage in just a few minutes.

Some common pitfalls you may encounter include:

  • Needing pre-authorization before starting treatment – make sure your insurance company will cover your care at a certain facility before starting treatment.
  • High deductibles – you might have to pay a few thousand dollars out-of-pocket before your insurance kicks in
  • Needing a referral – some insurance plans require an official doctor’s referral before they’ll cover mental health treatments
  • Treatment limits – you may only have enough coverage to stay in inpatient care a certain number of days, or receive a specific number of treatments per year 

The Role of Insurance in Accessing Mental Health Care

Your specific insurance plan can influence the treatment options that are available to you. While most mental health Insurance Los Angeles care covers talk therapy, inpatient hospitalization, partial hospitalization, emergency care, and medications, holistic practices, educational programs, halfway houses, and long-term treatments are generally not covered, nor are luxury facilities or alternative treatment programs. 

Comprehensive coverage is important because mental health care can be nuanced, and may require more than one type of therapy or treatment. A comprehensive treatment program might incorporate holistic practices, which can help you not only with the symptoms of your mental health disorder, but with healing as a whole person, gaining healthier habits, and finding new ways to reduce stress in your life. The more of these treatments that are covered by your insurance, the more likely you will be to engage in them, giving you a better chance of achieving your wellness goals, faster. 

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Moment of Clarity’s Approach to Mental Health Insurance Los Angeles

At Moment of Clarity, we have partnerships with insurance companies including Humana, Aetna, Cigna, and many more, and we accept a wide range of insurance plans. Because health insurance is intrinsically tied into the levels of care our patients can access, we’ve learned all there is to know about maximizing insurance, and getting the most out of your coverage. We can answer your questions, verify your coverage, and assist with billing, to make your life easier as you get the right treatment plan to help manage your symptoms. 

Mental Health Insurance Los Angeles: Tips for Maximizing Your Benefits

Advocating for yourself means knowing your rights, acting on your own behalf, and asking for clarification on anything that doesn’t make sense to you. The following are some tips for self-advocation:

  • Write down your questions and concerns beforehand, researching your plan and the types of care you may wish to pursue 
  • Take extensive notes whenever you speak to an insurance representative or health care professional, including dates, times, what was said, and the name of the person you’re speaking with
  • Don’t be afraid to ask as many questions as necessary, and be assertive enough to get the information you need 

Out-of-network providers may not take your insurance, but, depending on your plan, you may still be able to use out-of-network benefits to pay for some of the cost of care with them. They’ll charge you the full fee up front, and then you can send the bill to your insurance company for a reimbursement for the costs. 

Overcoming Insurance Challenges in Mental Health Care in Los Angeles

A large percentage of all mental health insurance Los Angeles claims are denied at first, and sometimes, it could be for a simple reason, like a misspelled name. If this happens to you, you can appeal the decision. Over 40% of all appeals result in successful reversals, so it’s worth looking into. 

The first step is to file a complaint and have the insurance company review your concerns. They must give you a written explanation for the denial. You will then have the option to state your case, prove you couldn’t find appropriate in-network care, the wait time is unreasonable, in-network treatment is too expensive, etc. The more evidence you can provide, the better, and don’t hesitate to ask for clarification if their reasoning is too vague or unclear. 

You can also file a formal appeal letter, and if your claim is denied again, you can request an additional assessment from an external independent review organization (IRO). The insurance company must follow the official ruling of the IRO. Filing a complaint to the state may help solve issues like not having appropriate in-network treatments available, unfair benefit limits, etc. If large amounts of money are at stake hiring a lawyer is not out of the question. 

If you don’t have insurance, some additional funding options may include taking out a loan, borrowing from friends or crowdfunding, or asking the treatment center about any scholarship-type funding, sliding-scale programs or payment plans they may offer. You can also look into lower-cost treatment options. Outpatient programs and virtual or group therapy are usually less expensive options.

You can also consider options like:

  • Free clinics and non-profit organizations
  • Community mental health centers 
  • Medical schools 
  • Hotlines and warmlines
  • Drop-in centers 
  • Local support groups
  • Providers in training
  • Local peer support groups

Therapy apps, college counselors, employee assistance programs, and nonprofit organizations can get you immediate help if you’re unsure where to turn. While these options won’t all help you get the full, comprehensive treatment you need, they may be an effective stopgap for you while you decide what type of care you want to pursue. 

Preparing for Your Mental Health Insurance Los Angeles Treatment Journey

At Moment of Clarity, we make it as easy as possible to start your mental health treatment right away. We can check your coverage in minutes on our easy to use online form, or you can give us a call and we’ll let you know what types of treatment your insurance will cover. No matter how complicated it may seem, our team is well-versed in the ins and outs of insurance premiums, deductibles, and networks, and can explain it to you in clear terms. You’ll have continual support from our helpful staff, every step of the way. Call us now at 949-625-0564 to get started.

Mental Health Treatment That Works

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This article has been reviewed by:

Dr. Girgis serves as Moment of Clarity’s medical director and is a triple board-certified psychiatrist.

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