National Suicide Prevention Lifeline

Call 1-800-273-8255. The National Suicide Prevention Lifeline is a national network of local crisis centers that provides free and confidential emotional support to people in suicidal crisis or emotional distress 24 hours a day, 7 days a week. 

Disaster Distress Helpline

The national Disaster Distress Helpline is available for anyone experiencing emotional #distress related to natural or human-caused disasters. Call or text 1-800-985-5990 to be connected to a trained, caring counselor, 24/7/365. disasterdistress.samhsa.gov

Get Professional Help If You Need It

Crisis Text Line

Text MHA to 741741 and you’ll be connected to a trained Crisis Counselor. Crisis Text Line provides free, text-based support 24/7.

The Trevor Project

Call 1-866-488-7386 or text START to 678678. A national 24-hour, toll free confidential suicide hotline for LGBTQ youth.

Trans Lifeline

Dial 877-565-8860 for US and 877-330-6366 for Canada. Trans Lifeline’s Hotline is a peer support service run by trans people, for trans and questioning callers.

Dial 2-1-1

If you need assistance finding food, paying for housing bills, accessing free childcare, or other essential services, visit 211.org or dial 211 to speak to someone who can help. Run by the United Way.

National Domestic Violence Hotline

For any victims and survivors who need support, call 1-800-799-7233 or 1-800-799-7233 for TTY, or if you’re unable to speak safely, you can log onto thehotline.org or text LOVEIS to 22522.

StrongHearts Native Helpline 

Call 1-844-762-8483. The StrongHearts Native Helpline is a confidential and anonymous culturally-appropriate domestic violence and dating violence helpline for Native Americans, available every day from 7 a.m. to 10 p.m. CT. 

The National Sexual Assault Telephone Hotline

Call 800.656.HOPE (4673) to be connected with a trained staff member from a sexual assault service provider in your area.

Caregiver Help Desk

Contact Caregiver Action Network’s Care Support Team by dialing 855-227-3640. Staffed by caregiving experts, the Help Desk helps you find the right information you need to help you navigate your complex caregiving challenges. Caregiving experts are available 8:00 AM – 7:00 PM ET.

The Partnership for Drug-free Kids Helpline

Call 1-855-378-4373 if you are having difficulty accessing support for your family, or a loved one struggling with addiction faces care or treatment challenges resulting from COVID-19 circumstances, the Partnership for Drug-free Kids’ specialists can guide you. Support is available in English and Spanish, from 9:00 am -midnight ET weekdays and noon-5:00pm ET on weekends. 

Physician Support Line

The Physician Support Line is available at 1-888-409-0141 every day from 8:00 AM – 1:00 AM ET. Physician Support Line is a national, free, and confidential support line service made up of 600+ volunteer psychiatrists to provide peer support for other physicians and American medical students.

Get Professional Help If You Need It

If the problems in your life are stopping you from functioning well or feeling good, professional help can make a big difference. And if you’re having trouble, know that you are not alone: One in four adults in this country have a mental health problem in any given year.

If you or someone you know is feeling especially bad or suicidal, get help right away. You can call 1-800-273-TALK (8255) to reach a 24-hour crisis center or dial 911 for immediate assistance.

Of course, you don’t have to be in crisis to seek help. Why wait until you’re really suffering? Even if you’re not sure that you’d benefit from help, it can’t hurt to explore the possibility.

A mental health professional can help you:

• come up with plans for solving problems
• feel stronger in the face of challenges
• change behaviors that hold you back
• look at ways of thinking that affect how you feel
• heal pains from your past
• figure out your goals
• build self-confidence

Most people who seek help feel better. For example, more than 80 percent of people treated for depression improve. Treatment for panic disorders has up to a 90 percent success rate.

Treatment for a mental health issue can include medication and psychotherapy. In some cases, the two work well together.

What, exactly, is psychotherapy? It’s a general term that means talking about your problems with a mental health professional. It can take lots of forms, including individual, group, couples and family sessions. Often, people see their therapists once a week for 50 minutes. Depending on your situation, treatment can be fairly short or longer-term.

Some people worry that getting help is a sign of weakness. If you do, consider that it can be a sign of great strength to take steps toward getting your life back on track.

FINDING HELP

• Get names of mental health professionals from your doctor, friends, clergy or local Mental Health America affiliate. If your workplace has an employee assistance program, it also can provide help. For more ways to find professionals, see Mental Health America’s How to Find Treatment FAQ.
• Interview more than one professional before choosing, if possible. You’ll want to feel comfortable with the person.
• You can see a psychologist, psychiatrist, social worker, pastoral counselor or other type of mental health professional. Of these, only a psychiatrist can prescribe medication.
• Sometimes, your health insurance company will cover only certain types of providers, so check how your plan works.

GETTING STARTED

If you’ve never been to a mental health care provider, it can feel a little daunting. Knowing what to expect and following a few suggestions can make it easier.

• Before you call, prepare a list of questions, like:
  • What experience do you have treating my issues?
  • Do you have a particular approach, expertise or training?
  • What does treatment cost?
  • Do you work with my insurance plan?
• When you call, you may get an answering machine or service. Leave times the provider can reach you and whether or not it’s OK to leave a message on your answering machine or with the person who answers your phone.
• Think about what traits you’d like in your provider. If you’re going to be talking to someone about your most personal problems, you want to feel comfortable. Consider if you’d prefer to see a man or woman, if you care whether the person is older or younger, or if there are any other traits that matter to you.
• During the first visit, you should expect that the therapist will ask questions about your background and why you’re seeking help. You can ask questions, too, like what treatment would involve and how long it might last. If you’re concerned, you can also ask about confidentiality. Usually, though, it’s understood that the provider respects your privacy—and that group members do too, if you’re meeting in a group.

GETTING THE MOST FROM TREATMENT

Your relationship with your provider is like a partnership. You’ll get more out of if you:

• Tell your provider your goals for treatment. Think about whether there are certain behaviors or issues you care about most.
• Keep an open mind. Be willing to consider new ways of behaving and thinking that might improve the quality of your life.
• Recognize that talking about personal issues can be tough, but it can help you overcome them. In time, treatment should help you develop more coping skills, stronger relationships and a better sense of yourself.
• If you think you’re not making progress, you should tell your provider. A good provider will want to work with you so you can get the most out of your sessions. If, after discussing your concerns, you’re still not comfortable, you might consider looking for another provider.
• Be honest. Your provider can’t really help you if you don’t share the whole picture. Don’t say you’re fine if you’re not.
• Share any concerns about your overall health. It makes sense that you should work with your provider on overall health issues because your mental health and overall health are so closely related.

WHAT ABOUT MEDICATIONS?

Some people with mental health issues find medications very helpful. Still, medications may cause side effects that can be annoying or sometimes even dangerous. You may want to weigh the pros and cons of a particular drug with your provider. You might also decide that you’ll try medication for a while and then re-evaluate.

If you decide to take medication, you may have to wait a few weeks before you start feeling better. Your provider will want to know how you’re doing and may suggest a different medication if the first one doesn’t work well. It can be dangerous to stop taking a medication suddenly, so always talk to your doctor first.

If your provider prescribes a medication, ask:

• What is this medication supposed to do?
• How soon should I expect to feel better?
• When do I take it?
• Do I need to avoid certain foods, drinks or other medications?
• Do I take it with food or on an empty stomach?
• What are the possible side effects?
• What can I do if I get side effects?

Brand Vs. Generic Vs. Authorized Generic Medications
Medications are often prescribed by their brand name. This was the name they were given by the company that first created them. Once these medications are no longer “on patent” other companies may start making them and offering them as generic medications. These go by chemical names. For instance, Zoloft is a brand name antidepressant, and its generic name is sertraline. Brand name drugs and generic drugs must have the same active ingredient, but they may have different inactive ingredients used to make them. Inactive ingredients can be things like coloring agents, preservatives, and fillers. The FDA requires generic drug makers to prove that their products are just as effective as the brand name drug before people are allowed to buy them. Your insurance company will often require that you be given the less expensive, generic version of medication (if one is available) unless your doctor determines that the brand name version is medically necessary.

When a doctor determines that a brand name medication is medically necessary for you or if you are seeking a generic that is identical to the brand but you have trouble affording the higher cost of the brand name medication, a third option may be available. This third option is an authorized generic. An authorized generic medication is a medication made by the original creator of the drug, using the exact same formula (including inactive ingredients) as the original drug. It is manufactured by the maker of the brand name medication and distributed by a special generics division of the drug company. An authorized generic medication will cost the same as a generic medication. But you may have to specially request it from your pharmacy because they may not keep it in stock. Not all medications are available in authorized generic form, but you can check to see if yours is at www.authorizedgenericmedicines.org/product-finder.

PAYING FOR TREATMENT

People often have concerns about paying for treatment. Some information may help you figure out what you can afford:

• If you have insurance, find out if it covers mental health services and the extent of the coverage, including limits on the number of visits allowed. To qualify for coverage, you might also be required to take certain steps, such as getting a referral from your primary care doctor.
• If you have Medicaid or Medicare, the Medicare Participating Physician Directory can help you find a provider who accepts Medicare. Your state Medicaid office, which you can find using the map on the National Association of State Medicaid Directors website, may be able to help you locate a provider who accepts Medicaid.
• If you have no coverage, you can ask your community mental health center about lower-cost services. In many states you can dial 2-1-1 to find a community mental health center. You can also contact your local Mental Health America affiliate or Mental Health America’s national resource center.
• If you want more information, see MHA FAQs on affordable treatment and paying for prescriptions.

ADDITIONAL RESOURCES

You’ll find more a lot more information through Mental Health America’s Frequently Asked Questions. You can also contact your local Mental Health America affiliate.

For descriptions of treatment options, visit the National Institute of Mental Health’s page on types of therapy.

After A Diagnosis

After receiving a diagnosis of mental illness, it is common to experience a range of emotions. For some people, a diagnosis can be a relief in that they are finally able to put a name to a problem.

For others, it can be a major blow. They may experience fear, anger, denial, shame or sadness, or they may wonder, “Why did this happen to me?” “How will this affect my life?” or “What will people think of me?”

Being told that you have a mental illness is not the end of the world, however. With help and support, you can recover and achieve your life’s ambitions. Of course, you will face many challenges as you begin your treatment, but there is hope. Mental illnesses are manageable. And there are a number of things you can do for yourself after a diagnosis to cope with the news, keep up with your treatment, and support your own recovery.

Be Hopeful

Above all else, it’s important to maintain a positive outlook. Here are a few things to keep in mind throughout your treatment and recovery:

You Are Not Alone In This Experience

Mental illnesses are common, affecting one in every five Americans.

You Can Improve And Achieve Your Goals

Today, many people who are diagnosed with serious mental illnesses are managing their conditions and regaining control of their lives.

You Can And Should Play An Active Role In Your Treatment

And the more informed you are about your illness and treatment options, the better you’ll be able to direct your recovery.

Learn All You Can About Your Diagnosis

If you’re ready, do some research on your particular illness, the recommended treatments, and other self-help ideas. The more you learn, the better you’ll be in working with your doctor and making decisions that feel right for you.

Again, talk to people who have had similar experiences, or mental health professionals you know and trust. The Internet can be a great resource for information about mental illnesses and treatment options. There are a number of websites, including Mental Health America’s, which can give you additional information. However, beware of websites that offer quick fixes or don’t reveal their sources.

Get Emotional Support

An important step in coping with a diagnosis is finding emotional support. Talk to friends and family members you feel close to and trust. They care about you and want to help you recover. Discuss your feelings about the diagnosis and any treatments or services that have been recommended. Don’t be afraid to let people know how to help you. This support will be important, both as you begin your recovery and when you have to deal with any setbacks along the way.

Also, you may want to meet people who have already been through what you are currently experiencing. This can help you prepare for what’s ahead and help you avoid any problems others may have been through in their recovery. Seek out self- help groups and support organizations that can reduce any feelings of isolation and loneliness.

Understand Your Health Care Options

Getting the services you need and paying for them can be a challenge. Your options may be limited by whether or not you have insurance, the type of insurance you have (private, HMO, Medicaid, Medicare), and the amount of coverage your plan provides for mental health care. There also may be a shortage of mental health professionals where you live, and it can be tough to get an appointment. But, remember, there are options. Follow the steps below to learn more about your options:

• If you’re employed and have a health plan, call your health insurer to see if they cover mental health services. Then find out which mental health professionals in your area are willing to accept payment from your insurance plan. If your employer has an Employee Assistance Program (EAP), they can also help you find services you can afford.
• If you get health care through a government program like Medicaid or Medicare, you should contact a community mental health center or local health department to see which doctors or programs accept this form of health insurance.
• If you don’t have health insurance, ask your community mental health center about reduced-cost (or sliding- scale fee) mental health services.

Develop A Partnership With Your Doctor And/Or Therapist

Once you have received a diagnosis and are in contact with a doctor or a mental health professional, here’s what you need to know about making the most of these relationships from the start:

Make Sure It’s The Right Fit For You

If possible, interview multiple providers; don’t be afraid to meet with more than one. You’ll want to find a doctor, mental health professional or peer counselor with whom you can relate. Ask them about their style of treatment and experiences helping other people with your particular illness.

Be Open With Your Doctor Or Therapist

Share how you’re really feeling. Go to your appointments with a list of questions you may have about your diagnosis and the therapies that are being proposed. After starting a course of treatment, you should begin to notice changes: relief from your symptoms, more self-assurance, and greater ability to make decisions. You should tell the doctor or therapist about your progress, or if you are having any problems. Don’t be afraid to voice your concerns.

Involve Your Family And Friends In Your Treatment

If you’re comfortable with that. Invite them to accompany you to an appointment or to sit in on a therapy session.

Getting the right help requires perseverance and self-advocacy. Take advantage of the options you have and continue to search for other ways to meet your needs. Remember – getting back to your life is the goal of recovery!

Paying For Care

Paying For Care – Without Health Coverage

Much of the health care system in our country depends on health care coverage, which is usually provided by a form of insurance. If you don’t have insurance, it can be difficult to pay for treatment unless you are independently wealthy. Consider the options below to obtain coverage; in the meantime see Finding Care to get immediate help.

Obtaining Coverage

You may be able to obtain insurance if you are not currently insured. Here are some options:

Medicaid

Medicaid is health care coverage offered in combination by the federal government and your state government. It helps low-income individuals in certain groups pay for medical care and prescriptions. Medicaid is not a typical insurance program with monthly payments and deductibles; Medicaid pays providers directly for your care. Low-income beneficiaries aren’t the only group to receive Medicaid, as there are several other qualified groups that are covered (although some of this will change in upcoming healthcare reform).

In addition to covering those who are low income, Medicaid covers:

• Pregnant women
• Women with children under 6
• Children between the ages of 6-19
• Supplemental Security Income recipients
• Young adults up to age 21 living alone
• People over the age of 65
• Those who are blind or deaf

Many states also have a “medically needy” clause, which means you can receive Medicaid without falling under any of those categories if your state determines that you need the medical treatment and you are under the threshold of the Federal Poverty Level.

Many people with mental illness become eligible for Medicaid by qualifying as disabled, either as children or as adults after age 19. Adults determined to be disabled receive Supplemental Security Income (SSI) from the Social Security Administration. SSI provides a small amount of monthly income To find out if you qualify for SSI, visit http://www.ssa.gov/ssi/text-eligibility-ussi.htm.

Many children can receive Medicaid even if they are not otherwise eligible through their State’s Children’s Health Insurance Program (SCHIP). SCHIP requirements tend to be broader.

If you believe that you meet the income and eligibility requirements, you can apply for Medicaid. For specific questions about eligibility for Medicaid in your state, you should call your state office. For more information on Medicaid, click here.

Medicare

Medicare, like Medicaid, is a health coverage plan run by the federal government. Medicare operates more like traditionally funded health insurance than Medicaid. Unlike Medicaid, Medicare is a federal program (without state differences) and is geared toward people based on age or disability status and not income. To enroll for Medicare, you must have received social security disability benefits (SSDI) for at least two years.

Medicare mimics a private insurance plan and has deductibles and co-pays. Medicare is structured into four parts, and you may be eligible for one or more of the parts.

• Part A – Medicare Part A deals with hospitalization and inpatient services.
• Part B – Medicare Part B deals with outpatient services and routine medical care.
• Part C – Medicare Part C or Medicare Advantage is a way to extend benefits of A,B, and D
• Part D – Medicare Part D deals with drugs. People with very low income get extra help paying for the prescription costs and deductibles in Part D.

Coverage Under Family Insurance

You may be eligible for coverage under your parents’ insurance plan if you are under the age of 26 due to new changes in the healthcare reform law. If you had previously been removed from coverage upon reaching age 22, you can re-enter the plan until you reach 26.

Employer Coverage

If you are employed, your company may offer health insurance as a benefit package. Employers may pay some or all of the monthly payments or premiums for your package. Employer plans tend to be more expensive and comprehensive than those on the individual market and frequently do not discriminate on the basis of pre-existing conditions. Often, employers who do not pay any part of your health insurance may still have a company plan that you can opt to enroll in.

COBRA

If you have recently lost your job, you may be eligible to keep your health insurance at a cost to you through the Consolidated Omnibus Business Reconciliation Act (COBRA). COBRA allows you to keep your health insurance for a specified period of time as long as you continue to pay the premiums.

School

If you are attending a state university as an undergraduate student, your state may offer a healthcare plan for you. Large schools and universities may have their own clinics or teaching hospitals. Some schools may offer programs for graduate students.

Private Insurance

If you are not able to obtain insurance coverage through family, work or school and you are not eligible for government insurance, you can consider buying insurance on the private market. Private insurance can be expensive, and you will need to evaluate your plan very closely.

Shopping For Insurance

There are several terms you will need to know before shopping for insurance:

Primary Care Physician – In many managed care plans or health maintenance organizations, you will have to choose a primary care physician, also sometimes called a general practitioner. Primary care physicians typically specialize in Internal Medicine or Pediatrics. Your primary care physician is the main doctor you will see for most of your ailments that don’t require urgent care. If you want to see a specialist, you may need a referral from a primary care physician.

Specialist – A specialist is a doctor such as an allergist, a gynecologist, or a podiatrist who specializes in treating one or more similar conditions or specializes in a specific age or gender group. Specialists may be able to run more tests and diagnose more problems than a primary care physician.

Referral – A referral is an authorization from your primary care physician to see a specialist or another doctor. It does not mean your insurance company will cover the cost.

Pre-approval – A pre-approval is when your insurance company “OKs” paying for a treatment before you take it.

Network – Insurance companies will typically list doctors or facilities as “in network” or “out of network.” Anyone who is “in network” has a pre-existing arrangement with your insurance company for how much can be billed and paid by the company. Out-of-network practitioners do not have a relationship with your insurance company; they may cost you more.

You will have to pick what kind of plan you want when you are shopping for insurance. There are several different structures of plans:

• A managed care plan, though often the most affordable, is the strictest when it comes to choosing your doctors. In a managed care plan, you may receive all of your services from pre-determined doctors or facilities. You might always have to go to Facility A to see your primary care physician and receive a referral before you can see a specialist chosen by your plan who also works in Facility A, and you may have to get all of your prescriptions at the same facility.
• A health maintenance organization is similar to a managed care plan, but instead of your doctors being chosen for you, you will have a choice as long as you remain “in network.”
• A point of service plan is similar to a health maintenance organization, but you may not need to visit a primary care physician for referrals to specialists as long as you stay within the network.
• A preferred provider organization (PPO) plan is the broadest type of plan, where you never need to see a specialist. You can go both in and out of network, but in-network care is cheapest.

There are several kinds of expenses involved when you are shopping for insurance.

• A premium is a monthly payment that you make to buy into the insurance,.
• A co-pay is any payment you make out of pocket when you visit a doctor or buy medication. For example, you may have to pay $20 when you visit your primary care physician and $40 when you visit a specialist.
• A deductible is the total amount you will have to pay out of pocket before your insurance coverage activates (although routine visits for general health may be excluded from this deductible). For example, you may have a deductible of $5,000. So if you are hospitalized and it costs $10,000, you will have to pay $5,000 before your insurance company will make payments on your behalf.
• A cap is the final amount that an insurance company will pay on your behalf either per year or over your lifetime, although this is going away. For example, you might have an annual cap of $100,000 and a lifetime cap of $1,000,000.

Generally, the higher the premiums are, the lower the deductible. Private insurance may also be more discriminatory than employer plans based on pre-existing conditions (although this is going away) and other statuses that affect your health (such as smoking or age). You may be able to find cheaper private insurance if you look for incentive-based plans that charge lower premiums for people who actively work to eliminate health risks such as smoking and obesity.

There are also some other things to watch out for:

A pre-existing condition is a health condition you have before you applied for insurance, such as major depression. Before the passage of the health care reform law, insurance companies could deny you based on a pre-existing condition, give you a very high premium and/or deductible because of your condition, or agree to cover any illnesses except those related to your pre-existing condition. This will change as health care reform goes into effect.

Your insurance will have a list of covered conditions and procedures. You should always read this to make sure your plan is comprehensive. Insurance companies can refuse to cover certain diagnoses and treatments not on the list.

Finding Care

If you are applying for insurance or you can’t find affordable health coverage, there are a number of ways that you can still get care. You should never be turned away from a hospital if you are having a medical emergency, regardless of your ability to pay.

Free Clinics are non-profit organizations that perform medical safety net services for free or at a highly reduced cost. You can find free clinics in your area by visiting http://www.freeclinics.us/.

Free Clinics provide safety net services, which are intended to help people who are ineligible for Medicaid and Medicare but can’t find affordable health insurance. They are often found in hospitals or as stand-alone facilities in densely populated areas of poverty. Some, but not all, free clinics provide mental health services in addition to preventative general health and maintenance.

Generally, free clinics will perform services for free, charge a nominal fee ($15/visit, for example), or initiate a sliding scale fee based on your income. , When visiting a free clinic, you may need to take your identification, as well as proof of income, such as a prior year’s W2 form. Some clinics may take walk-in clients on a daily basis; others are more like doctor’s offices that you will have to join.

Community Mental Health Centers offer low-cost or free care on a sliding scale to the public. Typical services include emergency services, therapy and psychiatric care for adults and for children. You can expect to go through an intake interview that determines the kind of care you will receive. Mental health centers also may offer a variety of services on a long-term basis for clients with persistent mental health conditions. Find your local mental health center by contacting your local government.

Local Nonprofits that aren’t specifically designated as health clinics may still have therapists, psychologists, or psychiatrists who donate their time and agree to see patients for free or at a reduced cost. Many groups will organize professionals who will donate some time each week or month to see patients. These professionals will often meet at drop-in centers or other clinics.

Even if community mental health centers or local nonprofits don’t have a pro bono program, they may know of other resources available to you in your community.

Medical Schools may provide another way of finding help. Students and interns may meet with clients at a highly reduced rate, if you are comfortable seeing them. These students will be under the supervision of a licensed professional.

Finding Supportive Services

If you are interested in finding supportive services in addition to professional counseling look for these options in your community:

Hotlines and Warmlines provide immediate support by telephone for people in emotional crisis and people with mental health conditions. Where hotlines provide emergency support and crisis intervention, warmlines provide assistance, comfort and referral services. Hotlines and warmlines can be lifesaving, they provide referral to help and care, and they are comforting because they are anonymous and easily accessible by telephone.

Drop-in Centers are organizations that are generally run by people with mental health conditions for their peers. A safe, accepting place to go for company and support. Drop-in centers may organize activities such as support groups or trainings, but they may also be more informal gathering sites.

Support Groups may meet at various places in your community such as churches, schools or government buildings. You can find information about support groups on the Internet, on bulletin boards at local mental health centers and restaurants, or by asking other people with similar conditions. Some support groups also meet anonymously on the Internet, posting on forums or using e-mail to stay in touch. Support groups should either be free or should have a very low cost to cover food or activities ($5 a meeting).

Find a support group here.

The American Self-Help Clearinghouse (http://www.mentalhelp.net/selfhelp/) and the National Mental Health Consumers’ Self-Help Clearinghouse (http://www.mhselfhelp.org/) maintain listings of support groups on a broad range of mental health topics. The National Mental Health Consumers’ Self-Help Group Clearinghouse also maintains a Directory of Consumer-Driven Services (http://www.cdsdirectory.org/) that includes peer-run organizations throughout the United States that offer a variety of supportive services and activities.

Help Paying For Medication

The ongoing cost of prescription medications can be a challenge, especially if you are taking more than one prescribed medication.

Some pharmaceutical companies offer prescription assistance programs to individuals and families with financial needs. These programs typically require a doctor’s consent and proof of your financial status. They may also require that you have either no health insurance or no prescription drug benefit through your health insurance.

In addition, there are county, state, and national prescription programs for which you may qualify and special drug discount cards offered by some pharmaceutical companies.

The Partnership for Prescription Assistance can help qualifying patients without prescription drug coverage get the medicines they need through the program that is right for them. Many will get their medications free or nearly free. For more information, visit http://www.pparx.org/ or call 1-888-477-2669.

Cutting Costs

It is important to let your doctor know if you cannot afford your prescriptions. In some cases, they may be able to give you free samples of your medications. Discuss with your doctor if switching to generic drugs or less expensive brand-name prescription drugs is a safe option for you.

When a doctor determines that a brand name medication is medically necessary for you or if you are seeking a generic that is identical to the brand but you have trouble affording the higher cost of the brand name medication, a third option may be available. This third option is an authorized generic. An authorized generic medication is a medication made by the original creator of the drug, using the exact same formula (including inactive ingredients) as the original drug. It is manufactured by the maker of the brand name medication and distributed by a special generics division of the drug company. An authorized generic medication will cost the same as a generic medication. But you may have to specially request it from your pharmacy because they may not keep it in stock. Not all medications are available in authorized generic form, but you can check to see if yours is at www.authorizedgenericmedicines.org/product-finder.

Another way to cut costs is to compare the prices of your prescription drugs at different retail pharmacies (CVS vs Walgreens vs Walmart, etc.). Many retail pharmacies list their prices for commonly prescribed drugs online. You can also call local pharmacies to request prices for your medications.

Consider using a prescription savings card such as FamilyWize as another way to cut costs. FamilyWize, a trusted MHA partner, is a community service partnership focused on enabling everyone, both insured and uninsured, to have access to more affordable medications.

The FamilyWize Prescription Discount Card:

• Is FREE for all
• Has no eligibility requirements
• Gives you discounts on your meds, whether you have insurance or not
• Saves you an average of 54% on mental health medications

Download a free card and learn more about FamilyWize here.

Medicare Part D

Medicare prescription drug coverage, also referred to as Part D, is a program that helps individuals who receive Medicare benefits pay for prescription drugs. This program covers both brand name and generic prescription drugs at participating pharmacies in your area. Everyone on Medicare is eligible, regardless of income, health status, or current prescription expenses.

There are two types of insurance plans that vary in cost and drugs covered:

1. Medicare Prescription Drug Plans, sometimes called “PDPs” only offer the Medicare drug benefit.
2. Medicare Advantage Plans, sometimes called “MA-PDs,” are managed care plans (like HMOs and PPOs) that offer more comprehensive health care coverage, to which the drug benefit will be added.

Extra Help is a program that helps eligible people with Medicare pay for some or most of their prescription drug costs. To learn more about Extra Help, visit http://www.medicare.gov/your-medicare-costs/help-paying-costs/extra-help/level-of-extra-help.html.

For more information on Medicare Part D visit http://www.medicare.gov/part-d/.

Want to find and compare Medicare drug plans or enroll? Visit http://www.medicare.gov/Default.aspx.

Paying For Mental Health Care – With Health Coverage

Dealing with insurance plans can be challenging, especially when you are already stressed and worried about mental health issues you or a loved one are experiencing. For this reason, it is best to understand your benefits before you need to use them, if at all possible. The following are steps you can take to make sure you understand your benefits so that you can do whatever is within your control to have your treatment covered.

Reviewing Your Insurance Policy

The first thing to find out is what mental health benefits your insurance policy offers. Review your insurance policy so that you are clear about whether your policy includes coverage for mental health services, types of services that are covered and the amount paid for these services, and any steps you must take to have treatment covered. You should have received a copy of your insurance policy when you enrolled in the program, whether at work or independently. If you did not receive a copy of the policy or have lost yours, you can call your insurance company and ask for another one to be sent to you.

Even if you have a copy of the plan, it is always helpful to speak to someone else and clarify questions. This way you can identify any possible points of confusion before you receive a bill. You should have a number on your card or on the website that will tell you whom to contact.

The following are some questions you will want to ask your insurance company, if possible, before starting treatment:

1) Do I need a referral from my primary care physician to a mental health professional?

Many insurance companies, especially Health Maintenance Organizations (HMOs) require referrals from a primary care physician to visit any specialist, including mental health professionals. If you do not receive a referral before visiting a mental health professional, your insurance company may deny your claims. If you think you require a referral, you should always get it in advance.

2) Do I need any pre-approval from the insurance company before I see a mental health professional?

A referral is an authorization from a doctor saying that the treatment is medically necessary; pre-approval or pre-authorization­ requires that your insurance company agrees to make the payment. You should call your insurance company to see if you need pre-approval, but you should also keep other questions in mind-how many visits are you approved for? Do you need a new approval for each visit? If you are going to be hospitalized or in inpatient care, how many days are you allowed to stay?

3) Do I need to see a mental health professional who is on a list provided by my insurance company (in a “network”) or am I free to choose any qualified professional?

If you need an “in network” provider, you can usually find a directory online or ask your primary care physician to help pick someone out.

4) Does the amount paid by my insurance company depend on whether I see a professional who is “in their network or preferred provider list” or “outside the network”? If so, what is the difference in the amount paid or percent reimbursement for “in network” vs. “out of network” providers?

“In network” providers are almost always cheaper than “out of network” providers, although whether you want to save money or visit a doctor you prefer is a choice you will have to make. Bear in mind that your insurance company may not always have a flat difference. For some companies, seeing an “in network” provider may cost you a $20 co-pay, and an “out of network” provider will cost you $30; in others, “in network” may cost you $20 and an “out of network” may cost you 20% – which could be significantly higher than $30.

5) Are there dollar limits, visit limits or other coverage limits for my mental health benefits? Is there a difference in what is paid for outpatient vs. inpatient treatment? If so, what are my benefits for each of these?

It is not uncommon, based on your state and your plan, to have limits on psychiatric visits or medication management visits. Your plan may limit you to something like 25 sessions with a psychiatrist each year, up to 7 days of inpatient treatment a year, and 12 medication management visits a year. If you exceed these services, you will have to pay out of pocket.

6) Is there a specific list of diagnoses for which services are covered? If so, is my diagnosis one of those covered by my policy?

Insurance companies often have the option to not include certain diagnoses in all policies. If you applied with your condition as a pre-existing condition, they may not cover anything related to that. Your insurance company will provide you with a list of covered and uncovered diagnoses.

7) What prescription benefit does my policy offer? What are the co-pays for medications? Are there different levels of prescription coverage depending on the specific medication? Do co-payments vary depending on whether the medication is generic or name brand?

Not all health insurance plans offer a prescription benefit plan in addition to a treatment plan. Even if you have a prescription plan, not all medications are covered. Many prescription plans have “formularies” that determine how much you pay for different classes or brands of drugs. Covered medications fall into three categories:

• Generic: These drugs are copies of brand-name drugs that have been on the market for a number of years and are often offered at very cheap prices.
• Preferred: These drugs are name brand but are available to you at a price below the retail price.
• Non-Preferred: These drugs are name brand but are not offered at a very large discount.

Insurance companies regularly update their formularies to classify drugs under certain payment categories. It’s best to ask your doctor to help you find out what payment category your drug is in before you go to the pharmacy to avoid an unpleasant surprise when the bill arrives.

However, many prescription medications for mental health conditions are very expensive and even with health insurance, you can find yourself paying a lot for a prescription.

Mail Order Pharmacy – Some insurance plans will allow you to order a three- month supply of maintenance drugs through the mail for a reduced, standard price.

Seek Outside Assistance – Go here to find out other ways to help pay for your prescription medication.

Seeking Help In Understanding Your Policy

If you have trouble understanding the policy, see if someone from your doctor’s office, your employer, or a trusted friend, can help explain the information.

If you receive health insurance through your employer, you may be able to go to your Human Resources department. If your company is large, you may have a dedicated Benefits Specialist who will be able to help you navigate health care. If you work for a smaller business, you will want to talk to the person who arranged the health care. They may not be able to help and their knowledge may be administrative, but they may help put you in touch with an advocate who can put you on the right track. You may be hesitant to admit to your employer that you need help with a mental health condition, but it is not legal for your employer to fire you over a disability.

If you have private insurance, you can contact your state Insurance Department or state Insurance Commissioner’s office (their consumer hotline may be the most helpful) for help in understanding your insurance policy. They can also help you find out whether your company benefits follow the state mental health parity laws (laws that guarantee equal coverage for mental health conditions as for other health conditions), and can assist you in dealing with your insurance company if you are having a problem.

Other Resources

The Center for Consumer Health Choices of Consumers Union has prepared a helpful guidebook “A Consumer Guide to Handling Disputes with your Employer or Private Health Plan“. Section 1 “Know your Coverage” and the “Checklist for Diagnosing your Coverage” may be particularly useful. You can complete the checklist once you have spoken with your insurance company. Once completed, the checklist can serve as a handy reference should you need services in the future.

The Simple Dollar has assembled a Social Security Disability Benefits Guide that explains how Social Security benefits work and how to calculate your benefits.

 

Resources: https://mhanational.org