SAMHSA Guide on Health Insurance and the Provision of Mental Health and Substance Abuse Services, Page 2
Because it’s provided directly by the US government’s National Mental Health Information Center, if you’re in the US, this guide may be just the thing to answer your questions about health insurance and the provision of mental health services and substance abuse services.
What about parity?
The Mental Health Parity Act, MHPA, of 1996 requires plans that offer mental health benefits to set lifetime dollar limits equivalent to limits for medical/surgical benefits; however, it does not require all plans to offer mental health benefits. Limits for substance abuse or chemical dependency benefits are not included in the determination of parity.
To learn more about the Mental Health Parity Act, access the CMS on the Internet at, cms.hhs.gov. If you are leaving a job for any reason and would like to learn more about continuing your current health insurance you can refer to epilepsyfoundation.org and the U.S. Department of Labor at www.dol.gov.
Many States have their own mental health parity laws. Some State parity laws deal with substance abuse benefits as well as treatments for mental illness. To learn more about parity and mental health coverage in your own State, contact your State department of insurance.
When should I use mental health or substance abuse services?
If stress, or interpersonal or job-related tension, is interfering with your daily life or if a medical condition is causing you mental anguish, you may want to seek mental health care. If habitual use of legal or illegal substances is negatively affecting your health and/or your daily life, you should seek treatment for substance abuse. In either circumstance, you should seek care as soon as possible, before you feel that you can no longer cope with the situation. These problems are just as important, and treatable, as medical problems.
Whom will I see?
When you seek MH and or SA treatment, you will see a variety of health care professionals. You may also deal with a case manager from the insurance company or treatment facility. Depending on the type of your insurance, a case manager (CM) may, in conjunction with your health care provider, assess your health needs, refer you to a specialist, coordinate the services that you will receive, and/or follow up on your treatment. In some cases, you may only speak with the CM over the phone; in others, the CM may be a qualified practitioner that you will actually visit. A qualified practitioner is any practicing health care professional licensed by the State to treat patients and provide health services.
The qualified practitioners that you may see during the course of your treatment include the following:
- Primary care provider (PCP), the physician who provides you with basic health care services;
- Physician assistant, a trained professional who provides health care services under the supervision of a licensed physician;
- Clinical psychologist, a professional with a doctoral degree in psychology who specializes in therapy;
- Psychiatrist, a professional who completed both medical school and training in psychiatry and is a specialist in diagnosing and treating mental illness;
- Clinical social worker, a professional with an advanced degree in social work who provides services for the prevention, diagnosis, and treatment of mental and behavioral disorders;
- Registered nurse, a trained professional with a nursing degree who provides patient care and administers medicine;
- Nurse practitioner, a registered nurse who works in an expanded role and manages patients’ medical conditions.
Anyone of these qualified practitioners is referred to as a specialist if he or she has received advanced education in a particular area of health care such as mental illness or substance abuse. Your PCP should communicate with your specialist(s) to monitor your progress and to make sure that you are not receiving any treatments that may react with other medicines or disrupt any other health conditions.
For more information:
SAMHSA’s National Mental Health Information Center
P.O. Box 42557
Washington, D.C. 20015
800-789-2647 voice
866-889-2647 TDD
http://www.mentalhealth.samhsa.gov
Centers for Medicare and Medicaid Services
7500 Security Boulevard
Baltimore, Maryland 21244-1850
1-877-267-2323 voice
1-866-226-1819 TDD
www.cms.gov
National Mental Health Consumers’ Self-Help Clearinghouse
1211 Chestnut Street – Ste. 1207
Philadelphia, Pennsylvania 19107
800-553-4539 voice
www.mhselfhelp.org
Rev. 01/2003
