How to Help Patients Get a Mental-Health Insurance Reimbursement

Patients often struggle obtaining mental-health insurance reimbursement. The reality is that a patient's mental-health issues are aggravated when he worries about whether the cost associated with vital treatment will be approved by an insurance carrier. Understanding how to get an individual mental-health insurance reimbursement is an important element in providing services to a patient.

Things You'll Need

• Claim form

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Instructions

• 1

  Contact by phone or email a health insurance company's claims department immediately upon a patient's admission to a mental health treatment program--outpatient or inpatient.

• 2

  Advise the claims department about the specific course of treatment prescribed for the patient.

• 3

  Explain that the course of treatment not only is preferred but is required to address a serious mental-health condition. Underscore that there is no other reasonable course of treatment available that is effective and as cost-efficient.

• 4

  Obtain a claim form from the health insurance company. The insurance carrier can fax or email this form to you immediately.

• 5

  Complete the claim form, obtaining any necessary supplemental information from the patient if possible.

• 6

  Include as much medical documentation available to support the claim form.

• 7

  Have the clinical director sign the claim form--noting her title--if she is available. In some instances, the fact that a clinical director signed off on a claim form assists in obtaining a positive response to the claim.

• 8

  Submit the claim form to the insurance carrier claims department.

• 9

  Prepare to respond to an initial denial of a claim made on behalf of a patient for mental-health insurance reimbursement. Some insurance carriers deny an initial mental-health claim as a matter of routine. Therefore, at the outset, familiarize yourself with the claims appeals process at a particular insurance company.