It’s the new year … do you understand the Affordable Care Act? Here is the short version: you are required by law to have health insurance. That doesn’t mean you will be thrown in jail if you don’t sing-up. However, if you don’t purchase a plan, you will face a harsher fine in 2016. For some folks, this is going to mean twice as much, as last year.
Those without health insurance were charged $325 or 2 percent of their household incomes–whichever was higher–in 2015. That penalty will jump to $695 per adult, or 2.5 percent of their income, in 2016, according to the government.
This brings me to my insurance “hack” – understand the ten essential benefits under the ACA.
That sounds kinda boring. Yes, but finding out that addiction, alcoholism and mental health services are covered, is kinda fun. The covered services include behavioral health treatment, counseling, and psychotherapy
Here is the not so fun part (referenced by Healthline):
Even with the Affordable Care Act (ACA), which mandated that certain mental health services be covered, many people don’t receive the care they need because there aren’t enough therapists to go around.
That’s despite the fact that 20 percent of children and 18.5 percent of adults have, or have had at some point, a seriously debilitating mental disorder, according to the National Institute of Mental Health (NIMH).
That means that millions of Americans with mental health issues — are receiving whatever care they do get from general practitioners.
A number of organizations have predicted a serious shortage of both doctors and nurses. Now, it appears the therapy field is experiencing the same phenomenon.
What’s Causing the Shortage?
It’s a simple case of supply and demand. The ACA dramatically increased the number of insured Americans, and the types of things health insurance policies must cover.
ACA also classified mental health professions as primary care professionals. This means patients can see a therapist without prior approval from their regular doctor.
So, does this mean mental health services are easier to come by in the United States? Not really. Michele Paiva, a licensed psychotherapist practicing in Pennsylvania, said the ACA has opened some doors to care, but that doesn’t mean the treatments are affordable.
“It is true more people are insured, but depending on the coverage that they have, they may or may not be able to afford therapy still, and the insurance is still dictating the therapy, as opposed to the therapist telling the insurance what the patient or client needs,” she told Healthline. “I find that my therapy clients are looking toward the self-pay option more and more. More now than ever before, therapists are not participating in insurance for this very reason.”
Besides dictating care, interactions with insurance agencies are often riddled with paperwork and other issues. Most therapists are self-employed, so taking time to get paid from insurance companies pulls them away from their clients..”
In fact, half of psychiatrists — who, unlike most psychologists, have a medical degree and can prescribe medication — don’t accept health insurance, according to a study in the journal JAMA Psychiatry.
More Barriers Between Professionals and Patients
Besides insurance, there are a lot of other things standing in the way of getting people the help they need. Part of the problem is that some insurance companies have stopped adding clinicians to their networks.
There’s also the fact that college tuition has skyrocketed in recent years. There’s no incentive to spend large amounts of money preparing for a career that may not pay enough.
“The rising cost of education is a barrier for many who are attracted to this profession. Money continues to be a factor throughout one’s career,” said Robinson, a licensed clinical professional counselor herself. “Mental health professionals often engage in years of unpaid clinical internships and residencies in pursuit of independent licensure.”
Before getting into the profession, Coleman recommends having a realistic and workable plan laid out beforehand. This includes knowing how long the process takes, including becoming established, marketing, and handling the business side.
What rights do you have?
Under the ACA, coverage for addiction treatment must be as complete as it is for any other medical procedure. Some of the things you can get with these insurance plans include:
- Addiction evaluation
- Brief intervention
- Medication for addiction treatment
- Visits to the clinic
- Drug and Alcohol appointments
- Home health visits
- Counseling for the family
- Anti-craving medication
ACA health insurance plans also helps with inpatient services like medical drug detox programs. Some states run their own marketplace sites for Health Insurance (these are separate from Healthcare.gov).
Before you pick a marketplace plan – ask:
1. What mental health and substance use disorder services are covered and what is the amount of copays and coinsurance?
2. Are your healthcare providers included in the network as preferred providers?
3. Are the medications, you take (or might need in the future) covered?
Don’t let confusing laws or doctor shortages fool you.
I can help. Don’t allow confusing laws dissuade you. Many addiction treatment centers accept ACA and similar Marketplace plans. An addicted person can buy one of these plans. If you missed one of the deadlines, there are special exceptions that you might be eligible for. Don’t let healthcare shortages prevent you from getting the best treatment. Many of the top treatment centers have empty beds. If you have partnerships (like we do) you know where to look.
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