Does Insurance Cover Psychiatrists?

Health insurance generally covers mental health services, including psychiatric care. Understanding your coverage can help you access the care you need while managing costs effectively.

Key Takeaways

• Whether you have employer-sponsored insurance or a marketplace plan, it should include mental health coverage
• Seeing in-network psychiatrists typically lowers your costs
• Read your plan details carefully, as coverage specifics vary

Mental health conditions affect more than 1 in 5 US adults. A psychiatrist can assess your mental health, provide a diagnosis, and develop a treatment plan to help you feel better. The good news is that your insurance plan can help cover these essential services.

How Do Insurance Companies Cover Mental Health?

Thanks to The Mental Health Parity and Addiction Equity Act of 2008, insurance providers must offer mental health coverage comparable to physical health coverage. This landmark law recognized the importance of mental healthcare and eliminated financial discrimination for insured individuals.

The Affordable Care Act further established mental and behavioral health services as "essential health benefits," including substance use disorder treatment.

Psychiatric Services Typically Covered by Insurance

• Initial psychiatric evaluation
• Medication management
• Emergency care
• Intensive outpatient services
• Partial hospitalization
• Inpatient/residential treatment
• Prescription medications

Keep in mind that every insurance plan is different, and mental health benefits may vary.

Does Insurance Cover Online Psychiatry?

Most insurance companies recognize the benefits of telehealth and cover telepsychiatry services the same way they cover in-person services. Since the COVID pandemic, telehealth has become increasingly common for mental healthcare delivery.

To confirm coverage for online psychiatric services, check your plan's mental health benefits or call member services.

Understanding Your Insurance Coverage Limitations

Different insurance plans may have different limitations. Examples include:

• Prior Authorization: Some plans require approval before starting treatment or certain medications
• Session Limits: While the Mental Health Parity Act generally prohibits hard limits on visits, some plans may require authorization for continued treatment
• Out-of-Network Benefits: Many psychiatrists are in-network, but out-of-network providers typically cost more

Out-of-Pocket Costs for Psychiatric Care

Even with insurance, you may have out-of-pocket costs:

• Copay: A flat fee you pay at the time of your visit
• Deductible: The amount you must pay before insurance starts covering services
• Coinsurance: A percentage amount dictating how much you cover (e.g., you pay 20%, insurance pays 80%)

Review your plan documents for information about covered services, copays, deductibles, and coinsurance. If you have questions, call your insurance's member services.

Do You Need a Referral to See a Psychiatrist?

Some insurance plans require a referral to see a psychiatrist. This is most common with HMO plans and less common with PPO plans.

If your plan requires a referral, see your primary care doctor first, who will then provide a referral to schedule an appointment with a psychiatrist.

Medicare and Medicaid Coverage

Both Medicare and Medicaid cover mental healthcare, including:

• Initial psychiatric evaluation
• Medication management
• Ongoing psychiatric care

Exact benefits vary based on specific plans, so check with your plan administrator.

Psychiatric Care at Next Step Psychiatry

At Next Step Psychiatry in Lilburn, GA, we believe quality mental healthcare should be accessible and affordable. We work with many insurance plans to provide comprehensive psychiatric services.

Our psychiatrists specialize in diagnosing and treating complex mental health conditions through medication management. We treat conditions including:

• Depression
• Anxiety disorders
• Bipolar disorder
• ADHD
• PTSD
• And more

Frequently Asked Questions

Does insurance coverage differ by plan type?

Yes, coverage varies significantly depending on your insurance company and specific plan. This affects whether you need a referral, your deductible and copay amounts, and whether you have out-of-network benefits.

What's the difference between a psychiatrist and therapist?

Psychiatrists are medical doctors with specialized training in diagnosing and treating mental health conditions through medication management. They can prescribe medications and provide comprehensive psychiatric care. Therapists typically provide talk therapy and counseling but cannot prescribe medications.