Getting the Most Out of Health Insurance for Mental and Behavioral Health Care

Thrive • December 1, 2021

As a new year approaches, many individuals have the opportunity to participate in Open Enrollment. During this time, it can be beneficial to understand your access to mental and behavioral health care coverage so you can make informed decisions that prioritize your well-being. Whether you are unsure of what mental and behavioral benefits your current provider offers or are actively trying to obtain coverage that includes these types of care, below is some helpful information about insurance to keep in mind. 

MENTAL AND BEHAVIORAL HEALTH INSURANCE STANDARDS

Mental and behavioral health conditions can disrupt the intricate relationship between the mind, body, and spirit, resulting in significant impacts to overall well-being. So, conditions involving the mind and behavior patterns require specialized care from experts who grasp their complex nature. Fortunately, mental and behavioral health care are considered essential health benefits by the Affordable Care Act (ACA). This means that to be in accordance with the ACA, health insurance plans must cover mental and behavioral health care without spending limits. Furthermore, ACA-approved plans or “Marketplace” plans must also cover pre-existing mental and behavioral health conditions.

Marketplace plans must include coverage of:

  • Behavioral therapy: Works to change unhealthy behavior patterns.
  • Cognitive Behavioral Therapy (CBT): Teaches individuals to practice mindful awareness of unhelpful thought patterns and reframe them in a more positive way.
  • Psychotherapy: Focuses on a broad range of mental and behavioral health conditions, such as anxiety, depression, and bipolar disorder.
  • Counseling services: Targets specific struggles, such as stress management or addiction over a shorter period of time than psychotherapy.
  • Group therapy: Allows individuals to be a part of a therapeutic group of people experiencing similar obstacles guided by a mental health professional.
  • Treatments for substance use: May include sober living, outpatient, and inpatient treatment programs.
  • Prescription medications: Can be used alongside therapy to aid mental and behavioral health challenges.
  • Online tools: May include virtual care options and healthcare provider directories. 

Understanding Parity and Common Breaches

In addition to these services, Marketplace plans must treat medical and mental health benefits with parity. As such, limits on mental health coverage cannot be more restrictive than limits on medical coverage. 

Unfortunately, parity is often violated by insurance plans. Understanding common breaches can help prepare you to advocate for your mental and behavioral health treatment with your insurance provider so you can receive the care you deserve. 

 Below are just a few examples of such breaches:  

  • A plan allows fewer visits for mental health care than for other types of health care.
  • A plan’s out-of-pocket costs for mental health care are higher than for different types of health care.
  • A plan requires prior approval for mental health care but not for other types of health care.
  • A plan won’t pay for mental health treatment that your mental health provider says you need.
  • You cannot find an in-network mental health provider or schedule a timely appointment.

If you believe your plan is violating parity, you can file an insurance complaint and appeal care denials. The National Alliance on Mental Illness (NAMI) offers additional guidance for navigating health insurance and advocating for your needs.

ASK THE RIGHT QUESTIONS

If you’re uncertain about your current mental and behavioral health care benefits or shopping for new health insurance, you may want to ask the insurance provider some of the following questions: 

  • Is my mental health insurance provider different from my medical insurance provider?
  • Do my benefits include coverage of outpatient and inpatient mental and behavioral health services?
  • Do my benefits include coverage of nutrition therapy and occupational therapy?
  • Are there any limitations to my mental and behavioral health coverage? For example, some insurance plans may limit the number of visits to certain health care providers.
  • Are there any exclusions to my mental and behavioral health coverage? For example, some plans will only cover the treatment of certain diagnoses.
  • Does my insurance require a referral or preauthorization for mental and behavioral health coverage?

Asking the right questions upfront can empower you with the knowledge necessary to take control of your mental and behavioral health care. 

SUPPLEMENTARY MENTAL AND BEHAVIORAL HEALTH INSURANCE FEATURES

If you’re in the market for new health insurance, you may also consider whether certain mental and behavioral health care services are offered, such as: 

  • An emotional support line 
  • Mental health virtual care (also known as telemedicine)
  • Access to mental health services without referrals
  • Online mental health screening tools
  • A directory of in-network therapists and psychiatrists

With 52.9 million U.S adults having experienced a mental illness in 2020 , services like the ones above are becoming more commonplace, making support for mental and behavioral health concerns more well-rounded, accessible, and financially feasible.

HELP WITH HEALTH INSURANCE AT THRIVE

Health insurance can be complicated, but Thrive Wellness can help make it simpler for you. Thrive is in-network with many major health insurance providers and also has the ability to secure single case agreements. Additionally, Thrive’s business office can work with you and your insurance provider to understand your benefits and advocate for your care while doing our best to obtain coverage for your treatment. Get in touch with us to begin your mental or behavioral health healing journey.

Download our free wellness guide.

Discover the power of small, sustainable changes with "How to Thrive: 10 Simple Habits for Healthy Living." This guide offers practical, easy-to-follow habits that promote physical, mental, and emotional well-being.

January 16, 2025
Support groups serve as a critical resource for those seeking a sense of community while navigating life's challenges. The benefits of support groups extend beyond the mere sharing of experiences; these groups provide valuable emotional support, foster a sense of community, and enhance mental wellbeing. In this blog post, we will explore what support groups are, how to find the right one for you, the various benefits they offer, and specific options available here at Thrive Wellness. What is a Support Group and How Can It Help Me? A support group is an organized gathering of people who share similar experiences or challenges, providing a space to find mutual support and understanding. These groups are safe and confidential spaces where participants can express their feelings, share personal stories, and receive emotional support from others who understand their unique struggles. Support groups are also powerful tools for reducing the feelings of isolation that can come with a challenging or traumatizing experience or being diagnosed with a mental health disorder. When you come together in the clinical setting, you can share experiences and gain unique insights from others. This sense of belonging often leads to improved mental wellbeing, as participants feel less alone in their struggles. Through the shared wisdom of the group and a therapist, members can learn important skills like coping strategies, gain encouragement, and develop a stronger sense of community and support. The collective strength that can come from these shared experiences contributes to personal growth, allowing attendees to thrive in their everyday lives. How Do I Find a Support Group That is Right for Me? Finding the right support group for you is essential to getting the most out of your experience. You can begin by researching local groups that align with your specific support needs and interests. Consider the focus of a group and whether it fits with the challenges you face. Healthcare professionals, therapists, or counselors can provide tailored recommendations and guide you to potential options. It's also important to consider logistical factors such as location, meeting frequency, and whether the group meets in-person or virtually. At Thrive, our admissions process for groups involves a 30 minute meeting with a group leader prior to joining to ensure that you are a suitable fit. What Are the Benefits of Support Groups? Support groups provide a multitude of benefits to help improve your emotional, mental, and social wellness. 1. Safe space for expressing emotions Support groups offer a safe environment where you can express your feelings and share experiences with others facing similar challenges with the assurance of confidentiality. This sense of emotional support is crucial if you are working though complex emotions, hardships, or trauma. 2. Sense of belonging and community Support groups help you to build a stronger sense of community. Through joining, participants can experience reduced feelings of isolation, knowing they are not alone in their struggles. 3. Exchange of advice and strategies Groups are great avenues for sharing knowledge, allowing members to exchange practical advice and coping strategies specific to their shared situations. In addition, therapists guide growth and provide practical strategies to help deal with challenges as they lead support groups. 4. Enhanced coping mechanisms Regular participation in groups can significantly improve your coping skills, enhancing your ability to manage anxieties and challenges associated with your experience or condition. Therapists are trained in teaching their groups effective coping skills specific to their needs. 5. Motivation for personal goals Groups provide a network of support, encouragement and motivation where attendees can cheer each other on in achieving their shared goals. Other group members can hold you accountable in pursuing your personal goals and staying on track with your treatment plan. What Support Groups Does Thrive Wellness Offer? Thrive Wellness offers a variety of support groups tailored to people's unique needs, ensuring comprehensive emotional and mental health support. Each support group is facilitated by experienced professionals offering guidance over the course of a group session. Groups being offered now at Thrive include a Perinatal Mental Health Support Group , a Social Anxiety Skills Group , a Body Image Skills Group , and a Teen Body Image Skills Group . Our admission process for groups is as follows: An individual therapist will submit a referral, then our client experience team will reach out to you to schedule a 30 minute group intake meeting with the group leader to ensure that you are an appropriate fit for the group. From there, you are admitted and scheduled to the group. All groups cost $50 for cash pay, however copays are collected when insurance is billed. Finding Strength Through Connection Support groups offer powerful benefits, making them a vital resource for those seeking emotional and mental support. Whether you are exploring what a support group is, searching for the right one for your needs, or looking into our specific offerings here at Thrive Wellness, the impact of these groups is real. By connecting with those who share similar experiences as you, you can find comfort, strength, and a renewed sense of hope, empowering you to face life's challenges with a team of people on your side.
January 9, 2025
Even if you look forward to the ski season all year, can't wait to read a good book by a crackling fireplace, and count down the days until you can frolic through fresh snow, you can also experience seasonal affective disorder or the winter blues. Dreary winter days stuck indoors can make it difficult for many to summon their natural cheerfulness, gratitude, and enthusiasm for life. This shift in mood may be confusing, especially if you're typically captivated by wintertime wonders. As the nights lengthen, days shorten, temperatures drop, and storm clouds block the sun, your mood can darken too. Essentially, the changing patterns of sunlight can disrupt your circadian rhythm (a kind of biological clock that influences your sleepiness and wakefulness patterns) and hormonal balance. Two conditions commonly develop during the winter: the winter blues and seasonal affective disorder (SAD), recently designated Major Depressive Disorder (MDD) with a Seasonal Pattern . Below, you can explore the differences between the winter blues and SAD, and find strategies to boost your mood and reclaim your motivation during the winter season. What Are the Winter Blues? Individuals struggling with the winter blues generally experience feelings of sadness, fatigue, and loneliness attributed to bleak winter weather. Although not considered a mental disorder, the winter blues may cause you to feel like a gloomy, less motivated version of yourself, while still being able to participate in and enjoy daily activities. Symptoms of the Winter Blues Feeling sad or down during the winter months Decreased motivation or energy Changes or difficulty with sleeping Causes of the Winter Blues Cold weather Shorter days, longer nights Decrease or change in exposure to sunlight and vitamin D production Risk Factors for the Winter Blues Lack of connection to community and social interactions History of depression or anxiety Environmental considerations (such as living in a climate that experiences particularly long or harsh winters) What is Seasonal Affective Disorder (SAD)? Also known as seasonal depression, SAD or MDD with a Seasonal Pattern is a subtype of major depressive disorder that interferes with a persons ability to engage in everyday life and find pleasure in activities that typically spark joy. In most cases, a person struggling with SAD will experience depression that begins in the fall or winter and ends in the spring. Less commonly, individuals may experience SAD in the summer, possibly brought on by exposure to too much sunlight that can cause sleeplessness, agitation, and anxiety. Symptoms of Seasonal Affective Disorder Depressed mood or sadness Decreased motivation or energy Hypersomnia (or excessive sleepiness and oversleeping) Eating beyond fullness Weight gain Loss of interest in hobbies or activities that usually evoke happiness Social isolation and withdrawal Increased feelings of agitation or irritability Difficulty concentrating Sense of hopelessness Suicidal thoughts Causes of Seasonal Affective Disorder Decrease or change in exposure to sunlight and vitamin D production, resulting in: Changes in circadian rhythm (disruption to your body's internal clock) Hormonal fluctuation, including imbalances of serotonin and melatonin Risk Factors for Seasonal Affective Disorder History of depression or anxiety Genetic factors Environmental considerations (such as living in a climate that experiences particularly long or harsh winters, resulting in decreased social interactions and activity) Ways to Boost Your Mood During Wintertime You can fight the winter blues and wrap yourself in warmth by incorporating some of the self-care strategies below into your wintertime routine. Eat intuitively. The way you nourish your body is directly connected to your mental health , but shorter days may disrupt breakfast, lunch, dinner, and snack time routines. By listening to your fullness and hunger cues, while also eating an array of foods consistently and adequately, you can promote your well-being including your emotional health. Move mindfully. Allowing yourself the time and space to move intentionally can do wonders for your mind-body-spirit connection. Research shows that mindful movement can help lower stress and anxiety in addition to relieving depression and improving overall mood. Commit to a consistent sleep and wake routine. By going to bed and waking up at the same times every day, you can practice good sleep hygiene , which can help you regulate your emotions effectively and promote overall well-being. Spend time outdoors in the sun. Sunlight promotes the body's vitamin D production and vitamin D is believed to affect the regulation of the feel-good hormone serotonin. By doing your best to soak up the sunshine when it graces the sky, you can help foster feelings of happiness. Maintain connections with family and friends. Loved ones can infuse dismal winter days and long winter nights with laughter, companionship, and a sense of belonging. Participate in service projects and other community activities . Offering your time to individuals in need and enveloping yourself in your community can bring you a sense of purpose, meaning, and connection. Your presence can light up the lives of others, making you feel good in turn. For more habits that create a well-balanced lifestyle and improve your mental and physical health, download our free guide "How to Thrive." Clinical Treatment for the Winter Blues and SAD If your sadness, lethargy, or other depressive symptoms begin to impair your daily functioning or extend beyond the season, we encourage you to speak with a healthcare provider. Licensed professionals can guide you in developing coping skills, reducing your depressive symptoms, and increasing your resiliency and motivation. In some cases, you may be prescribed light therapy or antidepressants to ease symptoms. You deserve to feel wonderful any time of year, and through outpatient therapy , Thrive can help you embrace the winter season with joy. Reach out to us to learn more. This blog post was originally posted December 22, 2021
January 2, 2025
Ah, New Year’s resolutions. The moment January 1 rolls around, it feels like everyone is armed with a laundry list of goals: lose weight, save money, drink more water, learn to play a new instrument. While these aspirations might look great on paper, the truth is they often come with a side of unnecessary pressure—and let’s be real, most of us abandon them by February anyway. This year, let’s flip the script. Instead of piling on more goals, how about taking a breath and reflecting on everything you’ve already accomplished? Trust me, there’s a better way to approach the new year without the stress of rigid resolutions. Why Resolutions Often Fall Flat The tradition of setting resolutions can feel exciting, but it’s easy to fall into the trap of overdoing it. We create lists of lofty goals, expecting ourselves to magically transform overnight. But what happens when life gets messy, work gets busy, or we simply don’t have the energy to crush it every day? The result is usually guilt, frustration, and a sense of failure—not exactly the motivational vibe we were aiming for. The problem with traditional resolutions is that they often overlook the importance of realistic planning and self-reflection. Instead of motivating us, they can pile onto the stress we’re already carrying. Give Yourself Permission to Pause Let’s start 2025 differently. Instead of asking yourself what you need to do, take a moment to consider what you’ve already done. Acknowledge the challenges you’ve navigated and the wins—big or small—that brought you here. This shift isn’t about giving up on growth or change; it’s about embracing a more compassionate, flexible approach to your well-being. Reflect on Your Wins From 2024 Before you set any intentions for 2025, pause and reflect on the year that’s just passed. Here are some questions to guide your thoughts: • What were my biggest wins from 2024? Celebrate the moments that made you proud. Maybe it was a professional milestone or simply surviving a tough season. Wins don’t have to be monumental to be meaningful. • What relationships were most meaningful to me? Think about the people who supported you, made you laugh, or helped you grow. How can you nurture those connections in the year ahead? • What surprised me most about 2024? Life has a way of throwing curveballs. Reflecting on how you adapted can help you appreciate your resilience and prepare for the unexpected. • What should I say “no” to? What would I like to say “yes” to? Sometimes, the key to growth is learning what no longer serves you. Saying “no” to draining commitments makes space for the things that truly light you up. • What am I most proud of and grateful for? Gratitude is a powerful tool for shifting perspective. Take time to appreciate the moments, people, and experiences that enriched your life. Start 2025 With Intention The beauty of reflection is that it allows us to set intentions that feel authentic and achievable. Instead of chasing resolutions rooted in perfection, focus on growth, gratitude, and balance. This year, let’s give ourselves permission to start small and prioritize what truly matters. Take a Self-Care Step With Our “Breathe Easy” Guide If you’re looking for a gentle way to begin 2025, our free Breathe Easy guide is the perfect place to start. It’s packed with simple breathing exercises designed to help you reduce stress, refocus your mind, and find a sense of calm—no matter how chaotic life feels. Download it today and give yourself the gift of a fresh start, one deep breath at a time. Let’s make 2025 the year we breathe easier, live more intentionally, and celebrate the progress we’ve already made. You’ve got this!
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