Health Care Battle 
Many families in residential treatment centers have struggled to get health care coverage for their child. The reasons are many. Some parents do not have policies that cover such treatment, some parents fail to put in for reimbursement during the year in which services were rendered, and others simply face difficult insurers who seem bent on not covering these programs.
And, despite being turned down, some parents have successfully sued for coverage and won. But that is a difficult and costly option for an uncertain outcome.
Because the reasons for failing to be covered are as varied as the number of families in treatment, we can offer no one protocol for ensuring coverage. So instead, we offer questions for you to consider as you analyze your treatment and leads you might follow up on to ensure you are getting the best possible information about what funds you are entitled to.
Step One: Gird Your Loins
First of all, it is important to contact your insurer early, to find out what they will and will not pay for. Keep notes of the dates of your calls and the persons to whom you have spoken.
The questions below will help you to gather important information about your mental health insurance benefits, which will assist you with making informed decisions about therapy.
- Does our plan cover mental health services?
- Does our child have to see someone on an approved provider list?
- If yes, where can we get a copy of the provider list in our area?
- Is there anything we need to do to have counseling sessions covered by insurance, if our child is living out of state?
- How does our coverage differ if our child sees a participating provider versus a provider "outside the network"?
- For how many sessions can our child be seen?
- What is the percentage co-pay for sessions?
- Do we have a deductible that we have to satisfy? If yes, how much?
- Is there a pre-existing conditions clause for our plan? If yes, what is the length of time we have to wait prior to our insurance covering a pre-existing problem?
- What is the effective date of the plan?
- Do we have to fill out any paperwork or be pre-certified prior to seeing a therapist?
- What information is needed from our child’s therapist in order for claims to be honored?
- Where do we send claims?
- How long does it take to receive a reimbursement?
Step Two: Contact Your Insurance Company
Call your insurance plan, or your company's benefits administrator, and ask for a verbal and written description of what coverage is provided for behavioral health treatments.
Many insurers offer coverage for mental health (MH) services and/or substance abuse (SA) treatments; some only cover substance abuse if it co-occurs with mental illness.
If you plan to use MH or SA benefits through your insurance plan, you may be required to get a referral from your regular doctor before you can receive services.
Additionally, your employer may offer an employee assistance program, or EAP. An EAP is a resource provided either as part of, or separate from, employer-sponsored health plans. Usually EAP visits are free, but the number of visits may be limited. Preventive care measures such as health screenings, mental health or substance abuse screening, and/or wellness activities will be provided. An EAP may not include all services and programs, but many provide aid to employees and their families for substance abuse, stress, depression, and other mental health issues. EAP visits are confidential; information discussed in these visits will not be shared with your employer.
Step Three: Get a Mental Health Care Provider
When you contact therapists ask them if they are accepting clients who are insured by your insurance plan. Also find out if they will require you to pay for sessions when you are seen or if they will bill your insurance company.
If You Leave Your Job
If you leave your job for any reason, you need to find out about COBRA. Ask your human resources department for more information. And don't forget to check out the Department of Labor's informational page on COBRA rules.
Next: Mental Health Parity
Did you get coverage for your child? Did you have to fight? What strategies can you pass along? Tell us about it below, or in the Community Forum.
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