All of the following individuals have a say in what services you get:
Unless you are committed to a hospital because you are a danger to
yourself or to others, you can decide which services you don’t want.
- Your doctor or therapist
To get services, you’ll have to have a health care provider, like a
psychiatrist or social worker, backing you up. If a medical
professional does not agree that you need the services you want, you’re
probably not going to get them.
- Your insurer and any management companies with whom your insurer contracts.
If your insurer (or the managed care company with which it contracts to handle mental health benefits) won’t pay for the services, you may not get them. However, you have the right to appeal and may get the services if your provider stands by you and is willing to help
State law sets out basic mental health services for which private insurers must pay. (See section on mental health parity.) Your or your employer’s contract with a private insurer also details what services the insurance company must offer you.
Insurers never have to pay for services that are not "medically necessary." Federal and state laws only make insurers pay for services if the services are "medically necessary." Generally, a service is medically necessary if it is the usual treatment for your condition and there is no less expensive treatment available that works.