It’s common for people to overlook mental health benefits when searching for health insurance plans. Most will simply examine plan options, their respective physical health benefits, and the associated premiums and deductibles. The problem with this is that individuals’ mental health is equally as important as their physical health. Furthermore, individuals who have never previously experienced mental health conditions will have difficulty recognizing the onset of a mental condition because the symptoms typically develop over time; and once they finally recognize their abnormal thoughts and behaviors, they’ve already become embedded in their daily lives. Mental health complications and physical health complications are similar in a number of ways. Specifically, they both require proper care and treatment in order for individuals to recover from their condition, and both mental and physical health problems will worsen if they go untreated. If a person selects a plan without mental health benefits, and they are forced to seek assistance for a mental health condition, they will have to pay out-of-pocket for psychiatric services. Just like other healthcare services, mental health care is often very expensive and presents a large cost burden on individuals without insurance plans offering mental health benefits. Thus, it is imperative for people to speak with their insurance providers about mental health benefits associated with their plans before purchasing a particular plan. Fortunately, Humana provides mental health benefits in the majority of their individual, family, and medicare plans.
The purpose of this section is to breakdown the different mental and behavioral health benefits provided by Humana’s Preferred Provider Organization (PPO) plans. The goal is to help you to understand the level of benefits generally paid for mental health services, chemical dependency services, and outpatient alcoholism services under their general individual and family PPO plans. All of their services require individuals and their families to meet their deductibles before any benefits are paid out. What this means is that people must pay a designated amount for covered healthcare services before Humana begins to pay for covered services.
Once their deductible has been met, they will only be responsible for making copayments and/or coinsurance for their covered services. A copayment is simply a flat rate that an individual pays for a covered service after their deductible. For example, if a person has met their deductible, and they are meeting their psychiatrist, Humana will require them to pay $20 for the visit, and Humana will cover the remaining costs. Copayments are typically inexpensive, and are used for routine checkups, medications, lab tests, and meetings with specialists.
Coinsurance is similar to copayments, but they are used for more expensive healthcare services such as prolonged hospital visits, surgical operations, intensive chemical detoxification services. Instead of a flat rate, coinsurance is presented as a percentage of the cost of a covered service after they have met their deductible. So let’s say that you had an operation on a broken bone that costs $1000. If you have a coinsurance rate of 20%, you would be required to pay $200 for the cost of the operation, and Humana would pay the remaining $800, or 80%. Copayments and coinsurance are inversely related to an individual’s premium payments, meaning that policies with lower premiums will have higher copayments and coinsurance and vice versa.
Inpatient services are those provided to individuals in the case that they are hospitalized for a mental breakdown or chemical dependency issue. The charts below breakdown the coverage structure for individuals with Humana’s PPO plans.
As the chart suggests, Humana will cover 80% of the costs for in-network services, and 50% for out-of-network services. The reason that there is a differential in the coinsurance payments for in and out-of-network services is because Humana wants to incentivize their clients to use their contracted healthcare service providers. If you have the ability to remain in-network, it is heavily suggested because it will help individuals minimize their out-of-pocket expenses.
Outpatient services are medical checkups for individuals that do not require and overnight stay in a hospital or medical facility. Outpatient services include wellness and prevention services, diagnoses for medical conditions, treatment for medical conditions, and rehabilitation services. In the case of mental health services, these would include meetings with your therapist or psychiatrist, diagnoses of mental health conditions from a psychiatrist, and psychotherapy or treatment for a mental health condition. Seeking assistance for a mental health condition is important for individuals’ mental and physical health because if they remain untreated, the conditions may worsen and create persistent and prolonged physical health problems such as chronic fatigue, tension, headaches, and nausea amongst a myriad of other problems.
Humana provides tremendous coverage for outpatient mental and behavioral health benefits. They only require individuals to make a $30 copay for a meeting with a therapist, and they will cover the rest of the cost. As an in-network mental health service provider partnered with Humana, the Clarity Clinic is able to provide individuals with highly personalized treatment and therapy plans for all cognitive, affective, and behavioral health conditions. We recognize that every individual and their situations are unique. So it is our goal to attentively asses each individual, their conditions, and the severity of their conditions in order to structure personalized treatment and therapy plan to help them effectively cope, and eventually overcome their condition. Healing takes time, and we understand how difficult it may be. Which is why we strive to provide individuals with the support, problem solving skills, and positive coping strategies necessary in order to make a full and sound recovery.