Insurance, Mental Health, and Texas Law
Historically, people seeking help for their mental health issues have faced many obstacles. At the forefront was the incorrect, yet persistent belief that mental illness is a petty problem, or merely a lack of willpower. In the past, some health insurance companies have even refused to offer mental health coverage to their clients.
Fortunately, Texas law now has certain provisions to protect people from this problem. Texas health insurance companies are legally required to offer coverage for the following problems, although clients are allowed to refuse this coverage if they choose:
- Alzheimer’s: Texas health insurance companies are not allowed to deny standard services to a person with Alzheimer’s or any other organic brain disease.
- Substance abuse: If a person seeks treat for a chemical dependency, his or her insurance should cover required treatments, although companies can limit how many series of treatments they will cover.
- Mental disorders with organic causes: In this context “organic” means rooted in biology, such as a brain injury or infection. Companies may choose not to cover mental problems without an organic cause as long as the problems are not severe.
- Serious mental illness: Texas health insurance companies are legally required to cover up to 45 days of hospitalization and 60 outpatient sessions per year. They are not allowed to impose a lifetime cap on an individual client. Definitions of “severe” mental illness can vary from one jurisdiction to another, so be sure to speak with your Texas insurance provider.
There can be many gray areas in these laws, such as whether a given treatment is necessary or not, so it is important for clients to be well educated about their individual policies and the law.
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