Navigating Insurance

Determining how to access mental health services can sometimes be overwhelming.  Below is a list of steps that will help you navigate insurance and seek the appropriate support for your child and family. If you have questions, contacting your insurance company is often a good start.

  • Determine what insurance benefits are for mental health services. Then,
    • Call insurance company
    • Request benefit summary
  • Find out specifics regarding what services are covered (length of stay, specialty assessments, number of sessions covered)
    • Who is in network (location)
    • Who/what provider is approved (i.e. find out what credentials are required)
    • How does the insurance company define a “service” (for example, is it residential treatment, day treatment, etc.)
  • What is the prior authorization process?
  • What documents does the insurance company need for approval? Do they need a clinician to assess the “day of”?
  • Do you have a co-pay?
  • Does the insurance company have a case manager assigned?

Accessing Services

Has your child had a psychological evaluation or diagnostic assessment in the past six months?

  • What did it recommend?
  • Was it written by a mental health professional?
  • Is the county involved with your child? For example, mental health case management.

Types of Insurance

If you do not have insurance, please contact your county’s social services office.

  • Medical Assistance (MA)
  • PMAP
  • Medicaid
  • Commercial
  • Private

Financial Support

You may wish to contact the mental health agency you wish to work with about financing options.    In addition, some Employee Assistance Plans (EAP) may include coverage.

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