How Mental Health Benefits Work for Top Bay Area Insurance Plans
Navigating health insurance benefits can be a bewildering, frustrating experience in the best of circumstances. And when you’re dealing with a mental health issue, bureaucracy and paperwork can feel overwhelming. Figuring out your mental health benefits is crucial for people in crisis (or even in everyday life). We wanted to help, so we tried to do that research for you. We’re testing whether an article like this can actually help people in the Bay Area. Please let us know if this information helped you, so we can figure out whether to do more in the series.
For this guide, we researched and dug into the mental health benefits for the top eight insurance carriers in San Francisco. We looked at top tier and lower tier plans, trying to understand what you can expect in terms of insurance coverage for mental health. If you’ve had an experience with insurance and mental health coverage or therapy, please let us know in the comments below. We want this information to be hands-on and useful.
Mental Health Benefits for Blue Shield of California
Blue Shield is one of the biggest providers of insurance in the Bay Area. If you’re working for a Bay Area-based company that provides health insurance, you were likely offered one of Blue Shield’s numerous plans, each of which has varying coverage.
If you’re a Blue Shield subscriber, the price you’ll pay differs depending on the plan you’re on. We focused on Blue Shield’s lowest tier (HMO) and the highest tier (PPO).
How Much You Can Expect to Pay for Mental Health Care on Blue Shield
If you’re on the lowest tier HMO: The Silver 70 Off Exchange Trio HMO…
If you’re on this Blue Shield plan, you can expect to get as many visits covered as you need, but you may need to ask your mental health provider to submit a treatment plan if requested. You will pay $40 copay per office visit with a mental health provider within network (more on that below). Other mental health services such as psychological testing and hospitalization will cost you 20% of total cost with coinsurance. No mental health coverage is offered for out of network providers.
If you’re on the highest tier PPO: The Platinum 90 PPO…
If you’re on this Blue Shield plan, you can expect to getas many visits covered as you need, but you may need to ask your mental health provider to submit a treatment plan if requested. You will pay $15 copay per office visit with a mental health provider within network (more on that below). Other mental health services such as psychological testing and hospitalization will cost you 10% of total cost with coinsurance. No mental health coverage is offered for out of network providers.
Here’s a link to more detailed information about Blue Shield of California’s plans to find your own price points.
What Mental Health Benefits on Blue Shield Really Look Like
Blue Shield uses a third party administrator, Mental Health Services Administrator (MHSA), for mental health benefits. With more than 2,000 providers to choose from, they hope you will be able to find help near you. Here’s what the actual experience of searching for a mental health provider looks like:
You start on on their site.
Then, when you actually try to search, you are popped into another site, which though it is described as Mental Health Service Providers, first asks whether you are a member. If yes, you’ll need to log in to access the provider directory. If no, you can search by location and plan type.
Once you enter your plan type, you’ll be taken to this screen where you’ll once again need to enter your plan type and location and choose Medicare or non-Medicare providers.
You’ll then be able to view a list of providers who fit the parameters you entered. The process is cumbersome, but in the end, you’ll receive a good list including provider contact information, provider mental health specialties and whether or not the providers are accepting new patients.
2. Mental Health Benefits for Kaiser Permanente
Kaiser Permanente has several plans with varying mental health coverage. Below, you’ll find information on their standard HMO plan. You can click here for additional information on plans and coverage.
How Much You Can Expect to Pay for Mental Health Care on Kaiser Permanente
If you’re on the Highest Tier HMO: Platinum 90 HMO…
For any outpatient mental health services, such as therapy or psychiatry visits, you’ll be charged a $15 copay per visit. For inpatient services, you’ll be charged a $250 copay per day for up to 5 days after which there is no additional charge.
The plan charges $7 per visit for mental and behavioral health group therapy in an outpatient setting.
If you are covered under the Community Health Care Program, there are no copayments for most covered services at Kaiser Permanente’s medical offices and hospitals.
What Mental Health Benefits on Kaiser Permanente Really Look Like
The Kaiser network includes 70 mental health providers in San Francisco and more than 1,200 providers in the bay area. If you choose a provider who is not in-network, you’ll need to pay out of pocket as no coverage is provided.
Here’s a look at what you can expect when you search for a provider on their provider website:
From here, you can search by specialty, location, and even gender. Tip: enter psychiatry in the specialty box for the most comprehensive results.
3. Mental Health Benefits for United Health Care (UHC)
UHC has several different plans and coverage varies. Below, you’ll find information on the lowest and highest tier plans. You can click here for additional information on plans and coverage.
How Much You Can Expect to Pay for Mental Health Care on United Health Care (UHC)
If you’re on the highest tier PPO: Select Plus PPO Platinum…
For outpatient mental health visits, the plan charges a $10 copay per office visit and the deductible does not apply. All other outpatient mental health services and inpatient mental health care requires 10% coinsurance and again the deductible does not apply.
If you’re on the lowest tier PPO: EPO Silver…
For outpatient mental health coverage, the plan charges a $45 copay per office visit and the deductible does not apply. All other outpatient mental health services and inpatient mental health care requires 40% coinsurance after the deductible has been met.
For any plan, if you choose to receive care from an out-of-network mental health provider, the plan charges 50% co-insurance for all mental health care after the medical deductible has been met.
What Mental Health Benefits on United Health Care (UHC) Really Look Like
UHC has over 1,000 mental health providers in San Francisco and the surrounding area. To find specific providers, simply click here and you’ll be taken to this screen:
You’ll then be asked to narrow your search to a specific mental health issue. You’re able to choose as many options as you need, and you can narrow your search by location and distance as well.
Once you’ve set your search criteria, you’ll see a list organized by distance from the location you entered. You can filter the list further by coverage/ plan type, license type, treatment options, availability, gender, languages, and board certification(s).
4. Mental Health Benefits for Cigna
How Much You Can Expect to Pay for Mental Health Care on Cigna
Cigna also has a wide variety of plans with differing levels of mental health coverage. For most plans, you will be charged coinsurance ranging from 20-50% for mental health services, both outpatient and inpatient and a deductible applies.
What Mental Health Benefits on Cigna Really Look Like
Cigna has an easy to use behavioral health directory where you can access a list of in-network providers in a variety of mental health sub-specialties.
You’ll first be taken to this screen:
You’ll then be able to view a list of providers matching your search criteria. You can also download a pdf copy of the list for your reference.
5. Healthy San Francisco
Healthy San Francisco is operated by the San Francisco Department of Public Health and available for those who cannot obtain health insurance. To be eligible for this insurance, you are:
Living on a combined family income at or below 500% of the Federal Poverty Level. Find out if you meet the income requirements.
A San Francisco resident who can provide proof of San Francisco residency*;
Uninsured for at least 90 days**;
Not eligible for public insurance programs such as Medi-Cal or Medicare
Age 18 or over
Participants may be treated for confidential mental health services, such as individual counseling for depression, anxiety, panic, or help with other emotional problems.
How Much You Can Expect to Pay for Mental Health Care on Healthy San Francisco
The cost for these services is determined by California’s Uniform Method of Determining Ability to Pay (UMDAP) and is based on household income and number of people in a household. More information about fees can be found here.
What Mental Health Benefits on Healthy San Francisco Really Looks Like
Click here to access their Participant Handbook.
To find a mental health provider, facility, or service, start with this page:
Then, select the service you need from the available tabs. By clicking on the Mental Health Services tab, you’ll be taken to a provider list which includes provider name, licensure, program name, contact information, and website.
6. San Francisco Health Plan
The San Francisco Health Plan provides low-cost healthcare to those who qualify. The amount you’d pay on this plan depends on your monthly income. If you are a San Francisco Health Plan member, you are eligible for mild to moderate mental health issues at no cost through Beacon Health Strategies.
You do not need pre-approval for mental health services if you are a member, but you will need to register with Beacon and go through a brief screening to receive therapy services. The therapist must be part of the Beacon network. There is no limit to the number of visits for any mental health service as long as they are medically necessary. (This is determined by Beacon in collaboration with your mental health care providers.)
Services provided include:
Individual and group mental health evaluation and treatment (psychotherapy)
Psychological testing
Psychiatric consultation
Mental health and alcohol use screening and counseling
What Mental Health Benefits on Healthy San Francisco Really Look Like
More detailed information on specific coverage can be found in this document and the plan also provides a comprehensive reference guide.
San Francisco Health Plan uses the same provider directory as Healthy San Francisco, so you’ll start at this page:
Then, select the service you need from the available tabs. By clicking on the Mental Health Services tab, you’ll be taken to a provider list which includes provider name, licensure, program name, contact information, and website.
7. Chinese Community Health Plan (CCHP)
CCHP offers numerous plans with varying coverage for individuals and businesses in San Francisco and northern San Mateo counties. Below, you’ll find information on the lowest and highest tier HMOs. You can click here for additional information on plans and coverage.
How Much You Can Expect to Pay for Mental Health Care on Chinese Community Health Plan
For all plans, the number of mental health visits per year is not specifically limited; it is based on what is medically necessary, which is determined by your primary care doctor and mental health providers treatment plan. In other words, the plan will cover the care you need based on your condition and treatment needs.
If you’re on the highest tier HMO: Ruby 10 HMO Platinum…
For outpatient services, the plan charges a $10 copay per visit. For inpatient services, you’ll be charged a $150 copay per day for up to 5 days.
If you’re on the lowest tier HMO: Opal 50 HMO Silver
For outpatient services, there is no charge for office visits; however, they do not apply to the plan deductible. You’ll be charged $50 per visit for all other services. For inpatient services, you’ll be charged a $250 copay per day for up to 5 days.
What Mental Health Benefits on Chinese Community Health Really Look Like
The provider network for mental health is comparatively small, with under 100 providers in the bay area. Out of network providers are not covered by the plan.
First, you’ll see this screen where you can search by plan type or specific doctor, facility or specialty:
Once you’ve made your selection, you’ll see an easily-navigable list of providers and facilities including location and specific CCHP plans accepted.
8. Health Net
Health Net also offers several plans. Following is a brief summary of the top tier plan (no deductible) and the highest deductible plan. Out of network providers are not covered for any plan. Be sure to check on pre-certification for all services, or you could be charged a $250 penalty.
How Much You Can Expect to Pay for Mental Health Care on Health Net
If you’re on the highest tier PPO: Platinum 90 PureCare One…
For outpatient care, there is no charge to see a preferred provider. For inpatient care, the plan requires you to pay 10% coinsurance.
If you’re on the lowest Tier PPO: Minimum Coverage PureCare One…
For outpatient office visits, there is a 0% coinsurance deductible which is waived for the first three visits. For care other than office visits, there is 0% coinsurance after the deductible has been met. For inpatient care, there is 0% coinsurance after the deductible has been met.
What Mental Health Care on Health Net Really Looks Like
Health Net has 822 providers located within five miles of downtown San Francisco. For more information on providers click here.
You’ll be taken to this screen:
After entering your search criteria, you’ll see this menu:
Click on Ancillary Services to search for mental and behavioral health providers or Doctors if you have a specific provider in mind. From there, you’ll need to enter your plan type and specific plan:
You’ll then see a list of in-network mental health for your plan which you can view in list or map view. It is also possible to export, print, save or email your results.
Conclusion
Understanding and using your mental health benefits can be a confusing process, but many plans now have resources specifically devoted to helping navigate mental health benefits. With a little research and help, you can get the help you need to care for your body and mind.
*The information was gathered in 2019 and is subject to change at any time. It’s intended to serve as a guide to help users navigate options within the mental health coverage they have. If you experience something different with one of these providers, please comment! We would love to keep this up-to-date and useful for all.*
About the Researcher
Lorna Rogahn is a medically-minded mom and wife who is passionate about mental health, medical research, parenting, and all things literary.
When not rearranging letters and punctuation on a computer screen, she spends her time chasing her speedy son and her even speedier greyhound.