NEWS RELEASE: Mental Health Awareness Month: How to Access and Navigate Mental Health Care with Insurance

For Immediate Release
May 1, 2025

Mental Health Awareness Month: How to Access and Navigate Mental Health Care with Insurance

COLUMBUS - Each year, around 2.3 million Ohioans experience a mental health condition - and for many, getting treatment and ongoing support begins with insurance-covered care.

As part of Mental Health Awareness Month in May, the Ohio Mental Health Insurance Assistance Office (MHIA) is encouraging individuals across the state to take an important first step toward care: understanding how to identify and access the mental health insurance benefits that may be in their health insurance plan.

But the journey can get complicated. Navigating insurance benefits, costs, care, and claims can be overwhelming, creating barriers to care. Fortunately, MHIA, the state's official mental health insurance resource, provides free, unbiased assistance.

Whether someone is an individual seeking care, a family member supporting a loved one, a behavioral health specialist or other healthcare provider, an advocate, or an employer, MHIA offers trusted information, personalized support, and educational engagement to help people get the most from the mental health insurance benefits in their health plan.

MHIA, part of the Ohio Department of Insurance, urges Ohioans to utilize its resources starting with these insights and tips:

Insurance Basics

• Mental health and substance use disorder insurance benefits must be treated like other health benefits in most health insurance plans.
• Financial requirements (copays, deductibles, coinsurance) and treatment limits (visits, provider types, locations) must be comparable to physical health coverage.
• Coverage typically includes therapy/counseling, substance use disorder treatment with inpatient and outpatient care, emergency services, and prescription medications.
• Plans may have referral and prior authorization requirements, like physical health services.

Identifying Coverage

• Benefits may be included in health insurance plans from employers, government programs, the Marketplace, and the private market.
• Review a plan's Summary of Benefits and Coverage and Certificate of Coverage documents.
• Contact the insurer, employer human resources office, or insurance agent.

Coverage Questions

• What are the copays, deductibles, and out-of-pocket costs?
• Are certain diagnoses or services covered?
• Are referrals and prior authorizations required?
• Are out-of-network services covered?
• What are the prescription medication benefits?
• What happens if a service is denied?
• What happens if a claim is denied?

Care and Insurance Claim Denial Rights

• Disagree with a claim decision? Submit an appeal to the insurer.
• Issues beyond claim handling? File a complaint with the Ohio Department of Insurance.
• Disagree with the appeal outcome or need a medical review? Request an independent review through the health plan, which will submit it through the Ohio Department of Insurance.

Ways to Help Someone

• Use the tools available at insurance.ohio.gov/getmhia.
• Identify the health insurance plan, insurer, and mental health/substance use benefits.
• Review the insurance coverage documents and in-network provider options.
• Understand costs before treatment begins and prior authorization requirements.
• If a service or claim is denied, contact the insurer before the Ohio Department of Insurance.

MHIA can provide help regardless of how someone gets their health insurance and if they are uninsured.

Visit insurance.ohio.gov/getmhia for mental health insurance information and to initiate an insurance complaint, appeal a care and claim decision, and request a speaker. MHIA staff are available at 855-GET-MHIA (855-438-6442) and getmhia@insurance.ohio.gov to address insurance questions and concerns.

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Contact: Todd Walker
todd.walker@insurance.ohio.gov