Accessing treatment
How do I access treatment using my U-M health insurance?
- All of the health care plans offered through the University provide coverage for treatment of mental health conditions and substance abuse.
- Each plan designates particular treatment providers (therapists, clinics, hospitals) to provide treatment for covered individuals.
How much does it cost to get treatment using my health care plan?
- Costs vary according to the insurance plan you have.
Costs for an appointment with a treatment provider for mental health conditions and substance abuse vary according to the insurance plan you have. Most plans require a co-payment, often the same as what you pay when you see your primary care physician. Other plans have an annual deductible which must be reached before they will pay for treatment services. All plans currently limit the number of treatment sessions they will pay for in a calendar year.
Because the cost of treatment to you will vary according to your plan, you need to check the details of your health insurance plan. You can do this by calling the plan’s customer service line or by checking your plan handbook. When you speak with the customer service representative at your health plan, he or she might use the term “behavioral health services” to refer to both mental health and substance abuse services.
How do I find and access a therapist using my health care plan?
- The two most direct ways to locate an authorized treatment provider are the following:
For treatment of mental health problems or substance misuse to be fully covered by your health insurance plan, you must go to one of the treatment providers authorized by your plan, usually referred to as “in-network” providers. Some plans will provide payment to out-of-network providers, but this is subject to certain conditions and requires a higher co-pay by the patient.
The two most direct ways to locate an authorized treatment provider are the following:
- Contact a counselor at either FASAP or UMHS EAP. Their counselors are knowledgeable about which therapists and clinics are authorized by the different health plans. If they meet with you in person, they will be able to suggest the names of therapists who may best meet your treatment needs and will assist with the referral process.
- Call the number listed for mental health and substance abuse, or behavioral health care, listed on the back of your health plan card. A customer service representative will give you contact information for a list of clinics and therapists from which you can select. When you speak with the customer service representative, he or she will likely use the term “behavioral health services” to refer to both mental health and substance abuse services. Many insurance plans also list their authorized treatment providers on their websites.
Can I go to a therapist in the community without getting a referral from my doctor?
- All U-M health insurance plans allow you to go directly to a therapist or counselor without getting a referral from your primary care physician.
- Most plans require pre-authorization for mental health and substance abuse treatment.
- You or your therapist can secure preauthorization.
Health insurance plans set the rules governing whether or not you need a referral for mental health or substance misuse counseling. Currently, all U-M health insurance plans allow you to go directly to a therapist or counselor without getting a referral from your primary care physician. However, if you have questions about this, call your plan’s customer service office, check the details in your health insurance plan booklet, or ask the counselor when you call to set up an appointment. To help you select a counselor, most plans have websites that provide information about authorized counselors or you can ask for information from their customer service offices.
Though current plans don’t require a referral from your doctor, most plans require pre-authorization for mental health and substance abuse treatment. This is obtained by either you or the treatment provider contacting your health insurance company to confirm your eligibility. Some plans require that you do this yourself; other plans allow the treatment provider to do this for you. It is a good idea to check the details of your insurance plan to determine your requirements; also you should confirm the pre-authorization requirements with your treatment provider when you set up your first appointment. To secure pre-authorization yourself, call the customer service or mental health or substance abuse number listed on the back of your insurance card or in your insurance booklet. For plans that don’t require you to personally secure pre-authorization prior to treatment, the treatment provider (clinic, therapist) will confirm your eligibility and get an authorization from your insurance plan for your treatment when you make your appointment.
If you are thinking of seeing a counselor in the community, you may find it helpful to talk first with a counselor from FASAP or UMHS EAP. At no cost to you, they can help you clarify the type of assistance you might need and help you locate an appropriate counselor authorized by your health care plan.
