Private pay residential treatment centers do not often contract directly with insurance companies, nor do they accept assignment of benefits. However, upon request, many programs are able to provide what’s called an “insurance superbill” to submit for reimbursement from your insurance provider.
What are "Insurance Superbills"?
Insurance superbills are formatted for the type of insurance you carry as instructed by the insurance company’s requirements for submission. Most insurance companies will accept a superbill, and provide partial reimbursement for covered services directly to the policy holder.
What Can Be Covered by My Insurance?
If your insurance currently covers licensed mental health therapy, psychiatry visits, or medication prescriptions, they may continue to be covered by insurance when billed appropriately and submitted via the superbill. Some services, such as specialized testing, require preauthorization in order to determine whether or not reimbursement is likely.
Clients may or may not be eligible for reimbursement. Sometimes there is significant reimbursement, and in some cases 100% reimbursement. In general, if insurance plans reimburse for services, they will typically cover some or all of the following: psychiatry sessions, prescription medications, individual therapy, group therapy, family therapy, or psychological testing.
Insurance plans rarely cover food, spending money, housing, academics, personal activities and services. Insurance benefits for mental health care has always varied from plan to plan.
For California Residents
The Mental Health Parity Act of 1996 requires insurance plans that offer mental health benefits to set limits equal to medical or surgical benefits. The law requires insurance plans that provide mental health coverage to cover any mental health disorder listed in the Diagnostic and Statistical Manual.
In July of 2000, the California Mental Health Parity Law (State Assembly Bill 88) requires health care service plans to provide coverage for bipolar disorder, major depression, obsessive-compulsive disorder, panic disorder and some others. Benefits mandated include outpatient services, inpatient hospital services, partial hospitalization services, and in some cases prescription drugs.
In October of 2008, the Mental Health Parity and Addiction Parity Act of 2008 was implemented, expanding mental health reimbursement requirements for group health plans with more than 50 employees or employer self-insured or self-funded plans. This law requires plans that have mental health coverage to cover any mental health disorder listed in the DSM (Diagnostic and Statistical Manual) and it prohibits insurers and health plans from imposing treatment limitations on mental health benefits that are more restrictive than those applied to medical services.