Is Mental Health Covered?

Over 4.7 million adults diagnosed with mental illnesses remain uninsured. According to Mental Health America, the leading community-based mental health nonprofit, Nevada ranks last when it comes to the mental health ranking of each state. It ranks 45th on the Prevalence Ranking that indicated the prevalence of mental health and substance use issues. On the […]

Over 4.7 million adults diagnosed with mental illnesses remain uninsured. According to Mental Health America, the leading community-based mental health nonprofit, Nevada ranks last when it comes to the mental health ranking of each state. It ranks 45th on the Prevalence Ranking that indicated the prevalence of mental health and substance use issues. On the Access Ranking, the state ranks 49th, which indicates the citizens’ access to mental health care, including treatment and health insurance Nevada. 

Even though Las Vegas is a populous city, it has about five psychiatrists per 100,000 people. To compare, Kansas City is roughly around the same size, but it doubles that figure. It only reaffirms the need for mental health care to be covered by health insurance Las Vegas. The poverty rate in the city is 16.2%, so health plans and insurance must be affordable even for low-income families. That is where the government’s joint federal and state program Medicaid comes in.

What Does the Program Do?

Medicaid is a public health insurance program for low-income Americans. It is an affordable health insurance option that finances health care expenses. The law provides health coverage that is administered by the states, according to different federal requirements. Medicaid pays for various mental health care services, too, including prescription drugs and treatments like inpatient care and laboratory services. Healthcare becomes more accessible to the elderly, people with disabilities, and families with low-income with Medicaid.

Households with an annual income of up to 138% of the federal poverty level may be qualified for Nevada Medicaid. The Medicaid Service Manual Chapter 400 states their philosophy believes that health services should be person-centered. Medicaid reimburses for community-based and inpatient mental health services, given that they are recommended by a physician or other licensed health practitioner.

There is also a law that ensures that mental health issues are taken as seriously as medical issues – the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA).

What Health Plans Does the Law Affect?

The MHPAEA states that the coverage for mental health, behavioral health, and substance use disorder services should be as good as the physical health (medical and surgical) coverage. The law requires that insurance providers should treat financial requirements equally, like limiting annual limits for mental health visits.

The law affects these mental health plans:

  • Employers and group insurance plans – There must be more than 50 employees.
  • Coverage under the Affordable Care Act (ACA) – a Health insurance Las Vegas created under the ACA is affected by the federal parity law.
  • Children’s Health Insurance Program (CHIP) – Each state has different CHIP program designs. However, they are all still under the parity law.
  • Medicaid programs – This differs from each program and state, so contact Medicaid providers to ensure that the law applies to Nevada Medicaid.

The law does not cover everything. The parity law does not apply to Medicare, similar to some state government employee plans.

How to Know If the Health Insurance Plan Provides Mental Health Coverage?

To be completely sure, check the details of the plan benefits. The information should be clearly outlined for individuals to understand the coverage. Contact the health insurance Nevada company directly for any questions that need clarification. ACA-compliant plans automatically have mental health coverage.

Under the Act, there are ten essential health benefits that must be covered in all health plans. Among these are mental health and substance use disorder services, prescription drugs, and rehabilitative and habilitative services. Because of the ACA, individuals with preexisting or history or mental health conditions would not be denied health insurance or be unfairly charged with a higher rate than others.

The mental health coverage of Nevada Medicaid can also reimburse necessary expenses. When recipients with mental illnesses or psychiatric conditions are admitted to a general hospital without a psychiatric unit, they can still be reimbursed. The admission must be certified as an emergency by the Quality Improvement Organization (OIO)-like vendor with proper clinical documentation from the hospital.

Nevada Medicaid also reimburses recipients under 21 for inpatient mental health services when the admission is certified by the QIO-like vendor and was approved by the public child welfare agency that holds custody over them. Learn how to use health insurance Las Vegas and always check the details of the mental health coverage.

How Can Mental Health Coverage Be Used?

When it comes to insurance coverage, learn about the copayments and deductibles regarding the payments. Copayments are the out-of-pocket costs for specific health services. A deductible is a certain amount that an individual pays out-of-pocket before the insurance company takes over with the payments.

Schedule a meeting with the care provider and confirm if the health insurance Nevada is accepted. It is necessary to check with the insurance company to know the critical details about the coverage. Out-of-network providers usually cost more, so take the time to review the in-network providers. As much as possible, learn about all the out-of-pocket costs.

For example, Nevada Medicaid’s Fee-for-Service (FFS) does not cover the reimbursement for individuals aged 22-64 who are admitted to an Institution for Mental Disease. This institution refers to a hospital or facility that treats and provides care to people with mental diseases. As a result, it encourages receiving care in general hospitals as opposed to state institutions because they would not get reimbursed otherwise.

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