Connecting with an individual’s health insurance company can assist with understanding how much the insurance plan will pay for and how much you will need to pay for mental health or substance use crisis services. A health insurance company can also help connect you to resources and maximize the benefits of membership.
Many insurance companies have a trained specialty Mental Health and Substance Use Disorder call line in addition to the Customer Service Line. Connect with the Mental Health/Substance Use Disorder/Behavioral Health line on the back of insurance card or contact the health plan’s Customer Services if a specialty line is not listed.
Glossary of Health Insurance Terms*
Annual Deductible – The set amount that must be paid each year by the member for covered healthcare before the health insurance plan begins to pay for services. This amount is agreed upon by the member at the start of the health plan and can later be adjusted.
Benefits – The health care items or services covered by an insurance plan. Your insurance plan may sometimes be referred to as a “benefits package.”
Case Manager – Individuals who assist and support in connecting a member to Mental Health and Substance Use Disorder treatment, resources, and support.
Co-pay – The amount the member is responsible to pay toward a service or medication at the time the member receives services or picks up a medication. Not all plans have co-pays.
Coverage – The amount paid by a health insurance plan for services provided.
Group – The group of people covered under the same health care plan and identified by their relation to the same employer or organization.
In network – A provider that has a contract with a health insurance plan to provide specific services to members of the health plan. Services with in-network providers are generally lower cost.
Member – The individual/s who are covered by the health plan, which is determined when insurance is set up. Sometimes referred to as insured or insured person.
Out of network – A provider that does not have a contract with an individual’s health insurance plan. This creates the potential for a higher cost for service that could be the member’s responsibility, partial or no payment could be made for services billed by provider.
Premium – The ongoing amount that must be paid for your health insurance or plan. You and/or your employer usually pay it monthly or yearly. The premium may not be the only amount you pay for insurance coverage. Typically, you will also have a co-payment or deductible amount in addition to your premium.
Provider – The person, clinic, hospital, pharmacy that is performing a health care service that could be billed to insurance.
Psychiatrist – Medical Doctor specializing in medication management with a focus on mental health diagnoses. Nurse Practitioners, Physicians, Psychiatric Pharmacists, and Physicians Assistants may also be able to provide medication management.
Telehealth/telemedicine – Video, online, or phone visits that allow members to receive services without face to face/in person contact.
Therapist – Provider who can diagnose mental health conditions and create and support a plan to reduce symptoms. Therapy can be done in an individual or group setting.
Wellness benefits – Additional services that are offered through health plans; for example, discounts to gyms/fitness centers, healthy eating programs, online mental health, and wellness programs.
*Definitions are not all encompassing and are subject to plan, provider, and services.
What if I don’t have health insurance?
Those without insurance can seek Mental Health or Substance Use Disorder Services by connecting with United Way 2-1-1, available 24/7. Call 211 for free and confidential health and human services information.
Additionally, those without insurance can receive peer support via phone or text when in crisis through the Minnesota Warmline at 877-404-3190 (or text “support” to 85511). Available Monday-Saturday noon-10pm.