Insurance Coverage and DSM Diagnoses

Insurance Coverage and DSM Diagnoses

According to the Office of the Assistant Secretary for Planning and Evaluation (ASPE), many people lack insurance to cover treatment for mental health and substance abuse disorders. In fact, one-third of people who have insurance cannot receive treatment for substance abuse, and one-fifth of them cannot treat mental health. Mental health and substance abuse disorders are now recognized as treatable illnesses, but not all insurance companies cover for them. Reform in healthcare will provide future changes in the coverage of these services.

Services Commonly Covered for Substance Abuse Diagnoses

The Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-V) includes both substance abuse and dependency as disorders, so insurance may cover any of the following services associated with rehab:

  • Medically supervised detox, which offers 24 hour care in an inpatient setting
  • Inpatient drug treatment, which may occur in a hospital or residential setting
  • Residential treatment, which often includes counseling, stress reduction, relapse-prevention support and 12-step programs
  • Outpatient drug treatment, which offers many services from residential treatment while allowing people to continue working, going to college and fulfilling family responsibilities

The services offered for these DSM diagnoses differ with each insurance plan. Contact your insurance provider to determine whether or not you have coverage for these services.

Services Commonly Covered for Mental Health Diagnoses

The DSM-V classifies mental health disorders, including mood disorders, anxiety disorders, eating disorders, personality disorders and many others. Health insurance usually covers any of the following services:

  • Inpatient hospital treatment for people who require active and constant monitoring by mental health professionals
  • Outpatient treatment programs, provided in settings outside of the hospital
  • Therapy that treats the underlying cause of a disorder while teaching patients to cope better in the future

Each insurance plan covers these services differently. If you are unsure what your insurance covers, then contact them or a health insurance professional.

Changes in Mental Health Insurance Coverage

According to the ASPE, the Affordable Care Act will require new small group and individual plans to cover mental health and substance abuse treatment by the year 2014. For those who change their insurance through this legislation, they gain access to mental health care that will address new issues. Many people avoid treating mental health and substance abuse because they cannot afford to do it, but as reported by the ASPE, the Affordable Care Act will give health insurance to 32.1 million individuals for mental health or substance use.

Help for Mental Health and Substance Abuse

Our admissions coordinators are available 24 hours a day to answer any questions you have about treatment for mental health and substance abuse. In addition, we can help you understand your insurance coverage, so please call our toll-free helpline today.