Learn about how your health plan covers mental health treatment. And what to do if you have any issues getting help.
Does my health plan cover mental health treatment?
Most plans do. There are exceptions for plans that aren’t subject to Texas law, like large employer plans.
For plans that do offer mental health treatment, they must offer coverage that is equal to medical treatment. This is called mental health parity.
What does mental health parity mean?
It means that the treatment of mental health conditions and substance use disorders must equal the coverage you get for health issues. Equal coverage includes things like financial requirements, deductibles, copays, and coinsurance.
What kind of mental health care should my plan cover?
Your plan should cover treatment for mental illnesses, like depressive and bipolar disorders, and autism spectrum disorders and substance use disorders.
What should I do if my mental health treatment isn’t being treated the same?
First, call your health plan and ask for an appeal. You can also ask for an external review, and someone outside the health plan will decide whether the services are covered.
You can call our Help Line and we’ll walk you through the steps. You can also file a complaint with us against your health plan. The Help Line number is 800-252-3439.
Where can I go for more information?
You can call the Texas Health and Human Services Commission behavioral health ombudsman at 800-252-8154. Also visit mentalhealthtx.org.
