New Year, New Benefits
As the new year begins, many people focus on resolutions, fresh starts, and setting intentions for the months ahead. One intention that often gets overlooked is reviewing mental health insurance benefits. It might not sound as exciting as hitting the gym or starting a new hobby, but it’s just as important—especially if prioritizing mental health is a goal for 2024.
Insurance plans often reset at the beginning of the year, and this can affect everything from deductibles to coverage limits. This is the perfect time to check in on benefits and understand the fine print.
Why It’s Important to Check Benefits Now
Changes to the Plan: Whether plans have been switched during open enrollment or remained the same, there’s a good chance something has changed. Coverage for mental health services, co-pays, and even the provider network might look different this year.
Changes to Different Insurance Provider, Group Numbers: If you or your employer has switched insurance providers/plans, you likely will have new information to share with your healthcare providers. Be sure to update ALL your providers of your new insurance provider and associated numbers. Failing to do so often means that your services might not be covered by your insurance (providers cannot bill without accurate information)., and you may end up with a bill from your provider.
Deductibles Have Reset: If a plan has a deductible, it likely starts over on January 1. This means the deductible may need to be met before insurance starts covering services. Knowing this upfront can help in budgeting for therapy sessions or other mental health support. If you have an HSA, be sure to share this information with your provider as well.
Maximize Coverage: Some plans have limits on the number of therapy sessions covered per year or require pre-authorization for certain services. Understanding these details now can help in planning care and avoiding surprises down the road.
Out-of-Network Options: If a therapist isn’t in-network, the plan might still offer partial reimbursement for out-of-network services. Be sure to check the process for submitting claims and what documentation is needed.
How to Review Benefits
Here’s a step-by-step guide to make the process a little less daunting:
Log Into the Insurance Portal: Most insurance companies have an online portal where benefits can be viewed. Look for a section on mental health or behavioral health services.
Verify that your plan, group number, and member id are the same as the previous year. If not, update your providers with this new information.
Review Key Terms:
Deductible: The amount paid out of pocket before insurance kicks in.
Co-pay/Co-insurance: The cost responsible for after the deductible is met.
Out-of-Pocket Maximum: The most paid in a year for covered services.
Check for In-Network Providers: If starting therapy or looking for a new provider, use the insurance’s search tool to find someone in-network. You can also look up current providers to make sure they are covered by your new plan. This can save significant money compared to out-of-network options. As of Jan. 2025, Mind Made Well is currently in-network with most BCBS PPO plans, Cigna plans, and Aetna plans. It is a good idea to verify in-network status with each provider, as provider directories are sometimes inaccurate and may include providers who are no longer in-network.
Understand Authorization Requirements: Some plans require may pre-authorization for mental health services, especially for higher levels of care like IOP. Handle this before scheduling appointments.
Call for Clarification: Insurance jargon can be confusing. Don’t hesitate to call the insurance company’s customer service line and ask questions about what’s covered and what’s not. The customer service line can also provide an out-of-pocket cost estimate to help you understand your total cost per session.
Advocate for Mental Health
Navigating insurance can feel overwhelming, but it’s worth the effort to ensure access to care. If something isn’t clear or barriers to accessing care arise, speak up. Sometimes, a quick conversation with a provider’s billing department, your insurance customer service’s line, or a patient advocate can help clear up confusion or find solutions.
Starting the year with a clear understanding of mental health benefits isn’t just about money—it’s about peace of mind. Knowing there’s a plan in place to prioritize well-being sets the tone for a year of growth, healing, and resilience.
Set aside 30 minutes to dive into these benefits. It’s a small step that can make a big difference.