It's important that you know exactly how much your insurance company will pay. Your insurance package may provide limited coverage for mental health services. It may help to ask your insurance company the following questions:
* Does my pediatrician need to formally recommend that my child see a mental health professional before the cost of the visit is covered? Or do I need approval through a separate process specifically for mental health services?
* Do I have to choose a doctor or counselor from an approved list? Does the list include professionals with expertise in children and their families?
* Are certain disorders excluded from coverage?
* Is there a lifetime or annual limit for mental health coverage? If so, what is it?
* Exactly how much of the cost of mental health services will I need to pay?
Your pediatrician may direct you to other resources if you don't have health insurance, if your health care plan doesn't cover mental health care, or if your health care plan doesn't provide enough mental health coverage to meet your family's needs.
In some communities, mental health centers or family service agencies charge based on what you are able to pay. Medicaid or the State Children's Health Insurance Program (SCHIP) — publicly funded programs to cover the medical costs of low-income children — also cover some mental health costs. In some states and for some diagnoses, these or other funds may be available, even if you have private insurance, for mental health services not covered by your health insurance.
If you have trouble obtaining or filling out a Medicaid or SCHIP application, ask the pediatrician's office for help. For more information about Medicaid or SCHIP contact the Centers for Medicare & Medicaid Services at 1-877-267-2323 or www.cms.hhs.gov
Self-help organizations may also offer counseling and support to children and their families. These organizations operate drop-in centers and sponsor gatherings for group discussions on specific topics, such as substance abuse or attention and learning problems. Your child's school may have guidance counselors and other professionals with training in behavioral health assessment and treatment. Clergy can also provide help. It's important to talk about each of these options with your pediatrician.
When speaking with or writing to an insurance company, keep these five points in mind:
* Don't be afraid to ask questions.
* Keep good communication records, including with whom you spoke and on what day and time.
* Be polite.
* Be patient.
* Be persistent.
Privacy Issues
The law protects your privacy related to mental health but allows your doctor to share information with other professionals involved in your child's and family's treatment.
In some cases, you will need to sign special forms authorizing the release of information. This may include medical, family, school and social history records. You can decide whether to give out this information.
At a certain age (which varies by state), your child may legally consent to or refuse care. Your pediatrician can help explain these laws and how they affect your child and your family.
It's common for parents and families to feel as if their child's problems are their fault. Many people are also afraid or embarrassed about a child's need for mental health treatment. While these feelings are normal, it's important that you not blame yourself for your child's problems. Your pediatrician, along with one or more mental health professionals, can help you better understand your child's behavior. They can guide you and other members of your family to help in the healing process.
If you are separated or divorced from your child's other parent, it's important to establish a plan for including the other parent in your child's assessment and treatment. Your pediatrician will help you decide whether scheduling visits together or separately, sharing reports, or making phone calls can best do this.
It's very helpful for you to continue to talk with your pediatrician and with the doctor or mental health professional who is working with your child.
* Does my pediatrician need to formally recommend that my child see a mental health professional before the cost of the visit is covered? Or do I need approval through a separate process specifically for mental health services?
* Do I have to choose a doctor or counselor from an approved list? Does the list include professionals with expertise in children and their families?
* Are certain disorders excluded from coverage?
* Is there a lifetime or annual limit for mental health coverage? If so, what is it?
* Exactly how much of the cost of mental health services will I need to pay?
Your pediatrician may direct you to other resources if you don't have health insurance, if your health care plan doesn't cover mental health care, or if your health care plan doesn't provide enough mental health coverage to meet your family's needs.
In some communities, mental health centers or family service agencies charge based on what you are able to pay. Medicaid or the State Children's Health Insurance Program (SCHIP) — publicly funded programs to cover the medical costs of low-income children — also cover some mental health costs. In some states and for some diagnoses, these or other funds may be available, even if you have private insurance, for mental health services not covered by your health insurance.
If you have trouble obtaining or filling out a Medicaid or SCHIP application, ask the pediatrician's office for help. For more information about Medicaid or SCHIP contact the Centers for Medicare & Medicaid Services at 1-877-267-2323 or www.cms.hhs.gov
Self-help organizations may also offer counseling and support to children and their families. These organizations operate drop-in centers and sponsor gatherings for group discussions on specific topics, such as substance abuse or attention and learning problems. Your child's school may have guidance counselors and other professionals with training in behavioral health assessment and treatment. Clergy can also provide help. It's important to talk about each of these options with your pediatrician.
When speaking with or writing to an insurance company, keep these five points in mind:
* Don't be afraid to ask questions.
* Keep good communication records, including with whom you spoke and on what day and time.
* Be polite.
* Be patient.
* Be persistent.
Privacy Issues
The law protects your privacy related to mental health but allows your doctor to share information with other professionals involved in your child's and family's treatment.
In some cases, you will need to sign special forms authorizing the release of information. This may include medical, family, school and social history records. You can decide whether to give out this information.
At a certain age (which varies by state), your child may legally consent to or refuse care. Your pediatrician can help explain these laws and how they affect your child and your family.
It's common for parents and families to feel as if their child's problems are their fault. Many people are also afraid or embarrassed about a child's need for mental health treatment. While these feelings are normal, it's important that you not blame yourself for your child's problems. Your pediatrician, along with one or more mental health professionals, can help you better understand your child's behavior. They can guide you and other members of your family to help in the healing process.
If you are separated or divorced from your child's other parent, it's important to establish a plan for including the other parent in your child's assessment and treatment. Your pediatrician will help you decide whether scheduling visits together or separately, sharing reports, or making phone calls can best do this.
It's very helpful for you to continue to talk with your pediatrician and with the doctor or mental health professional who is working with your child.
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