Tricare Insurance for Mental Health Treatment

How the Affordable Care Act Helps with Mental Health Coverage

Insurance for mental health treatment is more comprehensive since the inception of the Affordable Care Act. All insurance companies must provide mental health treatment due to this law.

All of the mental health conditions are viewed the same under the Affordable Care Act. As a result, even conditions that are resistant to conventional treatments are covered. Insurance companies are also required to treat both mental and physical conditions in the same way. The coverage provided for both types of conditions must be equal.

For example, if you are required to pay $25 for surgical or medical treatment, the cost of treatment for your mental health care must be $25 or less. Insurance companies are not legally allowed to charge you more for mental health care services due to the ACA.

How Co-Pays and Deductibles Work

Your insurance policy may require that you pay a deductible, a co-pay, or both. A deductible describes how much you are expected to pay before your insurance will start to share the costs with you. A co-pay is a single fee that you pay at the time of service. For example, you may be expected to pay $15 when you sign in for your appointments with a doctor. It will always be $15 for this fee and then your deductible amount is typically billed to you.

Once you meet your deductible, you generally will pay less out of your pocket. For example, if your insurance has a $2,000 deductible, once you pay $2,000, your insurance coverage should pay for the majority of your care for the remainder of the year. However, it may not take care of your co-pays. This will depend on your policy. Some people are still expected to pay their co-pays even after they meet their deductible. If you are still expected to pay them, the co-pays are usually still the same price before and after meeting your deductible.

Important Details About Tricare and Mental Health Coverage

Whether you are seeking transcranial magnetic stimulation or other mental health treatments knowing the facts about your insurance for mental health treatment will make it easier to navigate your options. Non-emergency mental health care does not require you to get any prior authorization for outpatient services regarding mental health care. You can utilize your coverage for counseling and therapy.

If you plan to use your Tricare health insurance at facilities outside of the military system, you will need to get a referral before seeing a mental health professional.

If your condition requires prescription medicines, you have to be under a provider’s care to get the medications covered. Other factors that might require authorization include:

• If someone has an exceptional condition and require an individual case management program
• If someone requires admission to a substance use disorder facility
• People who need inpatient psychiatric care
• If during a fiscal year you need to obtain outpatient mental health visits more than eight times

Benefits of TMS for OCD and Depression for Treatment-Resistant Patients

Depression and OCD are typically treated with a combination of therapy and medications. However, some people’s symptoms persist despite receiving treatment. In these cases, your doctor might recommend additional treatments, such as transcranial magnetic stimulation (TMS). People may get relief from TMS when conventional treatments fail to be beneficial.

TMS uses magnetic fields and it is a noninvasive procedure. These fields stimulate your brain’s nerve cells to help alleviate your OCD and depression symptoms. The magnetic impulses are repetitive when being delivered to your brain cells.

Experts do not fully understand how this treatment works on a biological level. However, it seems to affect how the brain is working to ease your depression symptoms.

TMS can be done in a few different ways. How your provider chooses to perform it will depend on your symptoms and their severity. As more research is performed, the techniques also change to make them more effective.

This treatment is often preferable over electroconvulsive therapy because patients do not have to be anesthetized prior to treatment. The risk of seizure is very rare with TMS where it is common with electroconvulsive therapy. When side effects do occur, they are generally mild and only last for a short period of time. They may include:

• Headache
• Spasming, tingling, or twitching in your facial muscles
• Where the stimulation occurs, you might experience some scalp discomfort
• Lightheadedness

Prior to TMS, you will undergo a consultation to make sure that you are a good candidate. The following factors might disqualify you from having TMS:

• You are pregnant
• You are taking certain medications or nutritional supplements
• You have damage to your brain
• You have certain other medical conditions
• You have had TMS in the past without favorable results
• You have headaches that are severe or frequent
• You have a history of seizures
• You have an implanted medical device made of metal

You can see that Tricare health insurance does provide coverage for mental health conditions. To get more information on your coverage, call Tricare or our facility you want to seek treatment at. We will guide you regarding how to get the most from your coverage.