How is Mental Health Covered Insurance wise in California?
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This page may have been superceded by the Essential Benefits Mandate of Mental Health in the Affordable Care Act.
Autism 7.1.2012 SB 946
(a) Every policy of disability (health) insurance that covers hospital, medical, or surgical expenses in this state* ... shall provide coverage for the diagnosis and medically necessary treatment of severe mental illnesses of a person of any age, and of serious emotional disturbances of a child, ... under the same terms and conditions applied to other medical conditions,
(b) These benefits shall include the following:
(d) For the purposes of this section, "severe mental illnesses" shall include:
(e) For the purposes of this section, a child suffering from, "serious emotional disturbances of a child" shall be defined as a child who (1) has one or more mental disorders as identified in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, other than a primary substance use disorder or developmental disorder, that result in behavior inappropriate to the child's age according to expected developmental norms, and ... (g) This section shall not apply to accident-only, specified disease, hospital indemnity, Medicare supplement, dental-only, or vision-only insurance policies.
CA Dept. of Managed Health Care on Mental Health Care
NAMI Guide to State Mental Health Parity Laws
Bazelon Center Paper on Health Reform & Mental Health
Blue Cross Brochures - check the Mental Health Section -
CA Mental Health Services Act - State Website Prop 63
Individual & Family Plan Underwriting Criteria - --AB 88 applies to in force policies - it doesn't require an Insurance Company to write you.
Sample Requirements for Mental Health Services to be reimbursed by Insurance - Page 17
Sample Response to a website visitors questions.Mental Health Resources
Sample Research - Reviewing an Insurance Policy and if it would cover LONGER than 50 days in a Psychiatric Hospital.
Medical Insurance Issues?Mr. Mip
Do you belong to an Employer Group of2 or more?
Employer Group with justONE employee or owner?
California Health Care Foundation
California mental health care parity law, requiring health insurance policies to cover treatment for mental illness on same terms and conditions applied to other medical conditions, applied to health plan beneficiary who did not live in or seek medical care in California, even assuming that parity law applied to policies written to cover expenses incurred in California, inasmuch as plan was written to provide benefits to California beneficiaries, and did not limit its application on basis of where individual beneficiaries lived or sought medical care. Thompkins v. BC Life and Health Ins. Co., C.D.Cal.2006, 414 F.Supp.2d 953
Summary:This bill prohibits health plans from basing medical necessity denials on whether the admission for mental health services was voluntary or involuntary, or on the method of transportation of the patient to the health facility. This bill also requires plans that offer mental health services to have information on their website that will assist enrollees in accessing mental health services. SB 1553 §1368.015, §1367.015Health & Safety Code
How to Obtain Behavioral Health Services
You do not need a referral to see a behavioral health specialist. You may self-refer to a specialist in Anthem Blue Cross' Behavioral Health network. Please confirm that the specialist is a participating provider at the time and location of service. For more information regarding mental health or chemical dependency services, please refer to the behavioral health disclaimer section in the Provider Finder section of Anthem Blue Cross’ website Member Access.
Outpatient professional mental health or chemical dependency services do not require an authorization or referral from your primary care physician (PCP) or medical group/IPA. Your PCP, however, may be able to recommend the appropriate type of provider for your needs.
In order to receive benefits under your HMO plan, you must access mental health or chemical dependency services from an Anthem Blue Cross (Blue Cross) Behavioral Health network provider. Please contact the provider directly to verify participation in the network and confirm that he/she is accepting new patients.
For behavioral health provider groups, please note that each individual professional in the group may not be listed on Provider Finder. Please call the group directly to verify those professionals participating in Anthem Blue Cross’ Behavioral Health network.