Trying
To Navigate The Mental Health System
Our
advice - be patient and persistent! The mental health system is complicated,
there are a limited number of therapists to treat the needs in the community,
and finding the right “match” between patient and therapist can take some time.
It is those patients who are persistent and educate themselves who have the
best chance to regain their emotional health.
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Educate
Yourself On Your Benefits
- If you are employed
and have health coverage through your employer, see if there are benefits
for mental health. (May also be called behavioral health.)
- Your employer may have
“carved out” the mental/behavioral health benefits. This means that
a separate company is responsible for managing all benefits, dollars and providers
associated with mental/behavioral issues and their treatment. The companies
that offer this service are often called “managed behavioral health organizations.”
Two examples in the Greater Cincinnati Region are Alliance Behavioral Care
and Magellan.
- If your employer
has this arrangement, there will often be different rules for accessing
these benefits than for benefits under the regular medical plan. You
would have received these materials at open enrollment or in the mail from
the managed behavioral health organization. If you cannot find these
materials, your human resources representative can help you.
- Your employer may have
an EAP (Employee Assistance Program)
- If your employer uses
an EAP, employees typically need to call them first to access providers for
mental/behavioral health. They tend to serve as a “gatekeeper” and “bridge”
to additional mental/behavioral/emotional health services. For more
information on EAPs, click here
- Your benefits will
have some provisions and specific rules that you need to know. Check
out:
- Pre-authorization
requirements – this would explain any approvals you need to get before you
can use the providers or services in the plan. This could be a variety
of requirements, including getting approval from your Primary Care Physician
first (this is called a “gate-keeper” model), calling a number and talking
with a “case manager” first, or any number of different procedures.
- Covered/Non-covered
Services – find out if there are any services that are specifically not
covered. This may include hospitalizations, medications, or certain
outpatient therapies. If you were to use
these non-covered services,
you would be responsible for paying for them.
- Co-Pays – this is
the portion of the bill you are responsible for paying to the provider/therapist.
This fee is usually due at the time you receive the service. The amount
of your co-pay depends on the benefit plan you or your employer chose.
- In-network/Out-of
network – In order to keeps costs reasonable to the employer and to you,
the employee, the insurance company, health maintenance organization or
managed behavioral health organization develops agreements with physicians,
providers and therapists to provide services for specific fees. These
agreements are called contracts. Contracted providers are considered
“in network.” Any provider not contracted with the organization is
considered “out-of-network.” Typically, visits to an in-network provider
will be covered in full with the exception of the co-pay. Visits to
out-of-network providers will cost you more out of pocket. The amount
will vary according to your plan.
- Limits of coverage
– find out how many visits you may use. Is there a limit to the number
used in a year, in a lifetime? What happens if you exceed those?
Will hospitalizations be covered?
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Educate
Yourself On Physical Health Issues
- See your Primary Care
Physician to rule out physical problems that may be contributing to your mental/behavioral/emotional
health issues.
- You might find that
your Primary Care Physician may be hesitant to talk to you about mental/behavioral
health issues. This may indicate the provider doesn’t feel knowledgeable
enough in this area, or that he/she is not covered through insurance for providing
this service (such as in a “carve out” plan.) Ask for your provider
for a referral (someone covered by your plan) to a qualified mental/behaviorial
health professional.
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Educate
Yourself On Strategies To Manage Your Emotional Health
- See if your symptoms
are typical for any particular diagnoses. We recommend seeing a qualified
therapist, but you may also want to research these issues using the internet
or library. Having this knowledge can help prepare you to partner with
your providers to improve your health.
- Learn strategies to
reduce stress (exercise, diet, meditation, yoga, etc.)
- Find a support group to discuss
your confidential personal issues.
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Educate
Yourself On Your Rights
- Confidentiality of
the care for your physical health needs and mental/behavioral/emotional needs
is protected by certain local, state and federal laws.
- In order for a provider
to talk to another physician, therapist, caregiver, employer, family member,
etc., regarding details of your diagnosis or treatment, you must give approval
in writing consenting to this. Ask your provider to see his/her consent
forms. Be sure your wishes regarding the sharing of information is
in writing and in your file.
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