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 “The DOI is pleased to offer resources to keep Illinois
residents well informed about health insurance coverage for mental
health and substance use disorders,” said DOI Acting Director Anne
Melissa Dowling. “Our staff is readily available to assist consumers
with reviewing insurance policies and addressing any questions about
seeking approval for behavioral health services.”
According to the National Institute of Mental Health (NIMH), one in
four adults has one or more diagnosable mental disorders. While many
of these conditions are common and treatable, NIMH estimates that
nearly half of those diagnosed are not getting the help they need.
The Department is encouraging Illinois residents to call OCHI
toll-free at 1-877-527-9431, Mon-Fri,
8 a.m. to 5 p.m., and talk to representatives who explain health
insurance coverage for mental health and substance use disorders,
help navigate the mental health parity process and assist with
appeals and complaints. The DOI also offers these tips for
navigating mental healthcare:
Do I or an adult family member need help?
A mental health condition may be the result of multiple causes.
Factors such as genetics, environment and lifestyle can play a role,
individually and collectively, in whether a mental disorder
develops. Though not a complete list, some signs you or a loved one
may want to speak to a health professional include: confused
thinking, prolonged sadness or irritability, feelings of extreme
highs and lows, excessive fears or worries, social withdrawal,
dramatic changes in eating or sleeping, strong feelings of anger,
delusions or suicidal thoughts. If in doubt, consider seeking
professional help. Treatment and recovery are ongoing processes that
can lead to improved health and wellness.
Does my child need help?
Many children and teens experience emotional and mental distress.
According to the American Psychological Association, young children
are less likely to get help for mental health than adults as it is
believed children will “grow out of it.” Warning signs of mental
illness include:
Extreme or strange behavior for the age and gender of the child such
as aggressive, withdrawn or hyper behavior. Sudden, difficult to
explain changes in behavior such as a steep drop in grades.
Monitor your child if you think something is wrong and reach out to
a school counselor, physician or mental health professional. If you
have medical insurance, you can call the behavioral health phone
line on the back of your insurance card for referrals to care.
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How do I find help?
If you are employed, check with your human resources department to
see if it offers an employee assistance program (EAP). EAP’s
generally include short-term counseling for employees and their
household members. These services can include providing support for
a number of issues such as substance use disorders, emotional
distress, major life events, personal relationship issues and other
types of mental health disorders. There are also many nationally
available hotlines to call if you need to speak with someone
immediately, such as the National Suicide Prevention lifeline at
800-273-TALK (8255). For general mental health questions, the
Substance Abuse and Mental Health Services Administration (SAMHSA)
is a good place to start. You can reach them at 877-SAMHSA7
(877-726-4727).
Finding Help if You Have Health Insurance
Your primary care doctor may be able to refer you to a mental health specialist.
Your insurance company can provide a list of providers covered under your
policy. Since 2011, mental health parity insurance laws applied to specified
group health insurance and health maintenance organization (HMO) plans in
Illinois. Further, in 2014 the federal Affordable Care Act (ACA) required, with
limited exceptions, that individual and small employer health insurance plans
include ten Essential Health Benefits (EHB) which include benefits for mental
health and substance use disorders. Illinois law requires mental health parity
for group, individual health and HMO plans, including qualified health plans.
Consumers with questions about mental health parity or the mental health
benefits under a health insurance or HMO plan can contact the OCHI for
assistance.
Finding Help When Uninsured
Start with your community health center. SAMHSA provides a behavior treatment
services locator to help you find one in your area. Other places to look include
university clinics and group therapy. Some mental health providers offer sliding
scale prices. It’s worth asking the provider if you can negotiate a reduced
rate.
What should I expect on my first visit of counseling or therapy?
Before your appointment, call the mental health professional’s office to discuss
his or her approach to treatment and working with clients. It’s also a good idea
to discuss insurance and payments options prior to your first visit. Be ready to
talk about the reason for coming to therapy. You might be asked about your work
and your family. To get the most out of your first session, think about your
goals, expectations and preferences in advance. Remember that your provider is
bound by confidentiality, so be open and complete in the description of your
concerns.
[Illinois Department of Insurance]
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