How Mental Health is Covered by Health Insurance in India

It has become an increasingly conducive trend for health insurance companies in India to provide coverage of mental illness treatments. Today we will take a close look at how mental health is covered by health insurance in India, what it involves, and how those in need can receive such care. 

How to Choose a Health Insurance Plan with Mental Health Coverage 

Not all health insurance companies cover mental health conditions comprehensively, so a really thorough study becomes necessary. When looking for health insurance plans with coverage for mental health issues, it is necessary to take into account several things. 

1. Ensure that your policy includes mental health coverage

Firstly make certain the policy that you're evaluating includes mental health-related coverage. Since the Mental Healthcare Act was implemented in 2017, insurers must cover mental health under the same terms as physical ailments. Make sure to carefully read policy documents for inclusivity. 

2. Consider its scope

In addition, the scope of coverage is critical. A good health insurance policy should have all types of mental health treatments covered, such as psychotherapy, counseling, and drugs--for as long as they are necessary. 

3. Opt for one that covers both in-patient and out-patient car

It is advisable to select plans which provide in-patient as well as out-patient care. Many policies may limit the coverage to hospitalization destination, leaving out services offered in essential therapy and counseling sessions taking place outside of a hospital. 

Therefore, consider plans that extend to cover both scenarios. Moreover, it's important to check the network of hospitals and mental health professionals covered under the insurance policy to ensure access to quality care. 

Limitations and Exclusions in Mental Health Coverage 

Even though coverage for mental illness has improved dramatically in these last few years, there are still some limits and exclusions you should know about. 

1. Waiting periods

Most insurance policies for mental illness have a period--usually between 2 and 4 years, during which you cannot make claims for treatments. This means that people can't get help right away just after getting their insurance. They will need to wait until after a few years have passed. 

2. Lesser coverage

And as if that isn't bad enough, some policies may only cover specific medical conditions such as major depressive disorder and bipolar disorder. "Lifestyle" diseases like anxiety or stress are frequently excluded. 

3. Higher chances of making out-of-pocket expenses

Another more common limit is capping benefits for aspects like mental care. This means, that although the plans may have this cover, the ceiling on what can be paid out will usually be lower for issues related to your mind than those which involve bodily damage. This may lead to out-of-pocket expenses, especially if long-term treatment is needed. 

4. Only specific types of treatments

Exclusions may also apply to specific types of treatment. For example, some policies may not pay for rehab from drug abuse or any new procedure that has not yet been generally recognized by medical establishments. Insurance companies also frequently exclude any mental illnesses that existed in the past. 

If a person is already being treated for a mental illness when he buys insurance, he may have to wait one entire presidential term before he can claim reimbursement for ongoing treatment costs. As a policyholder, make sure you read through the insurance paperwork carefully to know what is covered and what is excluded. 

How to File a Claim for Mental Health Treatment 

Under health insurance, filing a claim for mental health treatment is a simple matter. But it calls for compliance with the company's protocols. The first step is to notify your insurance provider as soon as you or a family member is diagnosed with a mental health condition that requires treatment. Depending on the type of treatment (in-patient or out-patient care), the actual claim process can vary slightly. 

1. In-Patient Treatments

For in-patient treatment, where the patient is admitted to a hospital for mental health care, you should submit the relevant medical reports and doctor's prescription or hospital admission papers together to the insurance company. 

2. Out-Patient Treatments

In terms of self-help treatments such as therapy or counseling sessions, the process may be somewhat more complicated. Many health insurance policies require the patient to first pay upfront for the sessions and then claim reimbursement. 

In this case, all receipts invoices, prescriptions, and consultation reports should be passed along to the insurers for further processing. Ensure that the mental health professional administering treatment is recognized as a provider by your insurance network because claims might be rejected if the practitioner is not covered under the policy.

After all the necessary documents are submitted successfully, the insurance company will process your claim, and once it has been approved, it will repay the expenses or pay the hospital bills directly, according to your care contract's terms. 

If your claim runs into trouble, it is wise to team up with the insurance company, find out why they denied your application, and provide whatever information might be needed to gain approval.