Using your health plan
Start with two phone calls: one to the office and one to your plan. Ask the office whether it accepts your specific plan, not just the insurance company, and whether it bills the plan directly. Ask your plan whether the psychiatrist is in network, what your copay or coinsurance is for a psychiatric evaluation and for follow-up visits, and whether the plan limits the number of visits or requires prior approval. Write down the date and the name of the person you spoke to.
Out-of-network care usually costs more. If a plan covers out-of-network medical care, federal parity rules say it must cover out-of-network mental health care in a consistent manner.
Mental health parity
The Mental Health Parity and Addiction Equity Act requires that, where a plan covers mental health and substance use disorder benefits, its financial requirements such as copays and coinsurance, and its treatment limits such as visit caps, cannot be more restrictive than those that apply to substantially all medical and surgical benefits in the same classification. The law does not require a plan to cover mental health benefits in the first place. Rules also reach non-quantitative limits such as prior authorization and network standards. Plans must make their medical necessity criteria for these benefits available on request.
Medicare
Medicare Part B covers a broad range of outpatient mental health services, including individual and group psychotherapy, psychiatric evaluations, medication management and intensive outpatient programs. Services can come from psychiatrists and other doctors, clinical psychologists, clinical social workers, nurse practitioners and others. After you meet the Part B deductible, you generally pay 20% of the Medicare-approved amount. Hospital outpatient clinics may add a separate copayment or coinsurance. Telehealth is a listed setting, and Part B covers one depression screening a year in a primary care setting.
If you pay without insurance
People who do not have or are not using health insurance can ask a provider for a good faith estimate of what care will cost. Providers must give one when you ask, or when you schedule care in advance, and scheduling at least three business days ahead triggers the requirement. According to the Centers for Medicare and Medicaid Services, you may be able to dispute a bill that is at least $400 more than the estimate.
The SAMHSA National Helpline, 1-800-662-4357, is free, confidential and open 24 hours a day in English and Spanish. It refers callers to local treatment facilities and, for people without insurance, to state-funded treatment offices, and many referrals go to facilities with sliding-scale fees or that accept Medicare or Medicaid.
Comparing offices
The directory lists offices with their phone numbers so you can call and compare. Ask each one the same four questions: the plans it accepts, the cost of the first visit, the cost of follow-ups and its cancellation policy. For help preparing, see your first psychiatry visit, and for video visits that can lower travel time see telepsychiatry.
Common questions
Does Medicare cover psychiatry?
Medicare Part B covers a broad range of outpatient mental health services, including psychiatric evaluations and medication management. After the Part B deductible you generally pay 20% of the Medicare-approved amount.
Do health plans have to cover mental health care?
The federal parity law does not require a plan to offer mental health benefits, but where a plan covers them, the limits and cost sharing cannot be more restrictive than those for medical and surgical benefits in the same classification.
What is a good faith estimate?
It is an estimate of what care will cost, given to people who do not have or are not using health insurance. Providers must give one when you ask, or when you schedule care in advance.
What should I ask the office about cost?
Ask whether the office accepts your plan, what the first visit and follow-ups cost, how many visits your plan allows, and what the cancellation policy is.