Health insurance is a type of coverage that pays for medical and surgical expenses incurred by the insured. Mercie Health accepts all major insurance and in network with the following:
- Blue Cross Blue Shield
- Tricare/Triwest and Medicaid are pending
Here are some key components of health insurance:
- Premium: This is the amount you pay to the insurance company to keep your policy active. Premiums are typically paid monthly.
- Deductible: This is the amount you pay out-of-pocket for medical services before your insurance kicks in. Once the deductible is met, the insured may still be responsible for a co-payment or a certain percentage of the costs, known as co-insurance.
- Co-payment: This is a fixed amount you pay for a covered health care service, usually when you receive the service.
- Co-insurance: This is your share of the costs of a covered healthcare service, calculated as a percent of the allowed amount for the service.
- Out-of-pocket maximum: This is the most you’ll have to pay for covered services in a policy period. Once you hit this limit, your insurance will pay 100% for covered essential health benefits.
- Network: This refers to the group of doctors, hospitals, and other healthcare providers that have agreed to provide medical services to a health insurance plan’s members at pre-negotiated rates.
Here are some key components of mental health coverage:
- Outpatient services: These are services that are typically provided in a clinic or office, such as therapy or counseling sessions.
- Inpatient services: These are services provided in a hospital or residential treatment facility, such as hospital stays for severe mental health conditions.
- Substance use disorder treatment: This includes services related to the treatment of substance use disorders, such as detoxification, rehab programs, and counseling.
- Prescription medications: Many mental health conditions are treated with prescription medications, which should be covered under a health insurance plan.
- Behavioral health treatment: This includes services such as psychotherapy and counseling, as well as mental health inpatient services and substance use disorder treatment.
- Pre-existing conditions: Under the ACA, insurance companies can’t refuse to cover you or charge you more just because you have a “pre-existing condition” — that includes a mental health condition.
- Preventive services: This includes depression screening for adults and behavioral assessments for children, which must be covered with no out-of-pocket costs.
Remember that the specifics of what is covered can vary greatly depending on your individual policy, and some plans may have limitations on certain services. It’s important to read and understand the details of your insurance policy, and don’t hesitate to ask your insurer if you have any questions about what is covered.
At a Glance
Dr. Sylvia Udokoro Nwakanma
- Doctor of Nursing Practice (DNP)
- Double Board Certified in Psychiatric Mental Health Nurse Practitioner (PMHNP-BC) and Family Nurse Practitioner (FNP-C)
- SAMSHA Certified Addictions Nurse Practitioner
- Learn more