How to Overcome Mental Health Insurance Denials
By Joe Feldman, President, Cover My Mental Health
Insurance Is a Major Barrier to Mental Health Care
Nearly everyone has a story about struggling to access mental health care—and insurance is often the reason why. For many, a mental health crisis is made worse by delays, denials, or lack of access to qualified providers.
Why Mental Health Coverage Gets Denied
- “Not Medically Necessary” Decisions
- Prior Authorization Delays
- No In-Network Providers Available
- Complex and Opaque Insurance Processes
Your Expectations of Your Health Insurer are Reasonable
- Access to competent clinicians… soon and nearby
- Coverage of care as determined by your clinicians
- Straightforward processes for claims processing and payment
What to Do When Insurance Says No…
- If you cannot locate a competent, in-network clinician à request your insurer identify one for you OR agree to cover your care through an out-of-network clinician
- If care has been denied à ask your clinician to provide a “medical necessity letter” to give your insurer; that clinician’s letter can help overcome the denial
- If your insurer still denies care or their processes are unfairly complex à file a “formal insurer complaint” directly with the insurer (this complaint is NOT an appeal)
What to Do When Insurance Says No
You don’t have to accept a denial. You can:
- Request an explanation
- File an appeal
- Work with your provider to document need
- Push for out-of-network coverage when necessary
How Cover My Mental Health Helps
We provide free tools and guidance to help patients, families, and clinicians navigate insurance barriers and access care—including for all of the steps described above.
Check out our specific resources for overcoming obstacles for eating disorder treatment.
Advocacy Works!
With our resources, patients and providers have successfully overturned denials for:
- Residential treatment
- Out-of-network care
- Medications and ongoing therapy
- Appropriate care for conditions like ADHD
You Don’t Have to Take “No” for an Answer
With the right support, it’s possible to overcome insurance barriers and get the care you need.