When it comes to mental health and substance abuse disorders, you have rights. Here's what you need to know about access to therapy and other behavioral health services and your coverage.
If you or someone you know is struggling with a mental health or substance use disorder, you are not alone. In California, one in six adults has some type of mental illness, and 8 percent meet the criteria for substance use disorders. The good news is that if you have health insurance, there are federal and state laws that ensure you get the help you need.
Mental health care and the law
Struggling with mental health disorders can be very difficult, but help is available and you can find the treatment you need. California has both state and federal laws governing health insurance coverage for mental and substance use disorders.
Under the Affordable Care Act.
Your mental health is just as important as your physical health. That is why federal law, under the Affordable Care Act (ACA), says that mental and behavioral health services are among the essential health benefits that must be covered. These include behavioral health treatment, such as counseling and psychotherapy, inpatient mental and behavioral health treatment, and substance use disorder treatment. All ACA-compliant health plans cover almost all mental health and substance use disorders, as well as alcohol and chemical dependency treatment.
In addition, federal law requires certain protections for mental health and substance use disorder benefits to make sure they are covered just like most medical and surgical services. This means that things like deductibles, limits on the number of days or visits, and ways to manage care must be the same for mental health and substance use as they are for other medical services.
Other materials from California
California law provides additional security by requiring every health plan in the state to cover certain mental illnesses, including the following:
- Major depressive disorder
- Autism or pervasive developmental disorder
- Bipolar disorder
- Panic disorder
- Schizophrenia
- Schizoaffective disorder
- Obsessive-compulsive disorder.
- Anorexia nervosa
- Bulimia nervosa
- Serious emotional disturbance in children under 18 years of age
These are all serious conditions that require immediate treatment. Your health plan must cover outpatient diagnosis and treatment, inpatient care, partial hospitalization, diagnostics, outpatient services, and prescription drugs (if your health plan covers prescriptions) under the same conditions as any other medical condition.
A California law signed in 2021 requires that when you see a mental health or substance abuse professional, you must be offered a follow-up appointment within 10 business days. This new law also applies to the health care provider who referred you to the specialist - an appointment with the specialist must be scheduled within 10 business days. The new law takes effect in July 2022.
Your path to treatment and help
If you need help, you can start your journey to treatment today. The sooner you get support, the sooner you can start getting better. Some insurance plans allow you to make an appointment directly with a therapist, but others may require a referral from your primary care physician or your insurance company. To find out more, go to your insurance company's website or call the number on your membership card. Some insurance plans have a behavioral health phone number you can call directly. Remember, it is important to ask for help - it is available to you and your loved ones.
Not sure where to start? Try using the Behavioral Health Treatment Services Finder. This is a completely anonymous and confidential resource for those seeking substance use disorder or mental health treatment in the United States. If you feel you are at risk of harming yourself, call or text the National Suicide Prevention Lifeline at 988, which is available 24/7. The three-digit number for the National Suicide Prevention Hotline, 988, works like 911, but for mental health emergencies.