Help during the holidays: Where to find it, how to use it

You probably know the basics of your healthcare coverage - preventive and acute care, emergency and urgent care, what's included and what's not. But often, people don't think about mental health benefits until they need them - which happens more frequently during the holidays.

Read on to find out now what you should know about your mental health coverage - locating it, understanding it, and using it - so if you or a family member needs help during the holidays, there's one less thing to worry about.

What is mental health coverage?

Your plan may refer to mental health benefits as behavioral - or behavioral and emotional health (BEH) benefits. It can cover treatment for mental disorders, chemical dependence, alcoholism, or any combination of those problems.

How do I know what benefits I have?

There are several ways you can find out:

Easy: Check your Summary Plan Description at Humana.com - Plans and Coverage Detail
- Log in to MyHumana and go to "Plans and Coverage," select the "Details" tab in your medical coverage plan file, and select "Download PDF" in the "Coverage Details" link
- Select Search - the binoculars icon in the toolbar at the top or on the left side of the PDF screen - and enter a word search for "mental health" or "behavioral health"
- Read carefully - the links will tell you just about everything you need to know:
  - What kind of coverage you have
  - What's not covered
  - What providers you can use
  - How to get care
Easier: Look on the back of your Humana ID for the phone number for behavioral health authorizations and claims
Easiest: Call your company's benefits administrator or human resources representative and ask about your company's mental health benefits

Interpreting the language:

If you look in your health plan description, you'll probably think you need a translator. Fortunately, your plan description includes a "Definitions" section. To make it even easier, these are some of the frequently-used terms related to behavioral health benefits:

"Outpatient" is anything that doesn't involve overnight admission to a treatment facility. "Intensive outpatient" treatment doesn't involve an admission, but it does include more frequent therapy sessions. It may include more focused therapy that digs deeper into problems, causes, and possible solutions.
"Residential treatment" is treatment in a licensed, 24-hour residential facility that's not a hospital.
"Partial hospitalization" is treatment in a hospital or a licensed, 24-hour facility, in an accredited program that helps patients make the transition back to everyday life after longer-term treatment. It requires several hours of focused, multi-disciplinary treatment several days a week, but it doesn't include overnight stays at the facility.
"Pre-authorization" or "pre-certification" means the provider has to call the number on the back of your insurance card and get approval to treat you before Humana can cover your care. Depending on your plan, the requirement may be only for inpatient care, or it may be for both inpatient and outpatient - it varies from one policy to another.
"PAR provider" means a healthcare provider who's in your network, and "non-PAR provider" means one who isn't in the network. "PAR" is insurance-speak for "participating." Depending on your plan, you'll be responsible for more, or sometimes all, of a non-PAR provider's charges. Remember, anything printed in italics in your Coverage Details document is in the "Definitions" section.

What kind of therapist should I see?

Your coverage document will tell you, but, basically, any provider listed in Physician Finder Plus is in your network. Just be sure to follow your pre-authorization requirement.
There are three basic classifications of therapists. Each takes a different approach to treatment, and they usually focus on different needs.
- A social worker concentrates on interpersonal relationships and interactions to help you see how others influence your behavior, how you influence theirs, and how those influences affect events in your life. Call a social worker for help with family issues, work conflicts, and other interpersonal difficulties.
- A psychologist focuses on your thoughts, feelings, and attitudes, and can help you understand how they affect the things that happen in your life. Psychologists may specialize in depression and anxiety that aren't necessarily caused by specific conflicts, in Post-Traumatic Stress Disorder, or in helping people with ADHD, to name just a few.
- A psychiatrist is an M.D. who can prescribe medication for disorders and illnesses like ADHD, chronic depression, anxiety, panic attacks, and psychoses like schizophrenia. A psychiatrist may also be a psychotherapist, but more likely, he or she will recommend "talk therapy" with a psychologist or social worker if you need it.

How do I find a therapist?

It's possible that your company offers an Employee Assistance Program (EAP) that contracts with mental health providers to allow employees a set number of visits for help with short-term problems. Sometimes an employer requires an employee to participate in an EAP if problems affect the employee's work, but you can also ask for help even if no one else knows you're struggling. Check with your HR department or benefits administrator to find out if you have access to an EAP.

If your company doesn't have an EAP, or if you think you may need more time to fix your problem, here are some steps to take:

First, think about what kind of help you need.
Is this a relationship issue - trouble with your teenager, or a conflict with your spouse? Look for a marriage and family therapist. This could be someone with a master's in social work (MSW) or a psychologist.
Do you feel depressed or think you're worrying about things out of proportion to their actual importance? Are you overwhelmed with stress, even more than usual? Your first choice may be a psychologist who can help you find solutions to your depression, anxiety, or stress. Your psychologist may suggest that you also visit a psychiatrist for medicines that can help, depending on the severity of your symptoms and how long they last.
Has something happened to throw you off your stride? Possibilities could include a personal loss, being assaulted or robbed, witnessing something terrible like a bad wreck, or even having a close call - for example, a fall that could have killed or seriously hurt you, but didn't. Look for a psychologist who has experience working with people who have Post-Traumatic Stress Disorder (PTSD).
Have you felt this way for several weeks or months without much change? Again, you can call a psychologist - or you may want to contact a psychiatrist first, especially if your symptoms are severe or they've been going on for a long time without much relief. There's a chance your brain chemistry affects those symptoms, and medication may help you feel like yourself again.
You may want to talk to people you trust - friends and family, clergy, or other healthcare providers - and ask if they recommend someone in particular. A conversation with someone who knows you can lead to a contact that fits you well.
Next, look in Physician Finder Plus for mental health professionals.
At Humana.com, go to the Members page and select the type of healthcare provider you're looking for under "Provider Search" - in this case, "Other Facility/Service" - and follow the instructions to reach the provider search page. You'll have to give some information about where you live and your plan so you get the right list.
Select "Mental Health and Substance Abuse" from the types of providers in your area, and click "Search." You'll get back a list you can search alphabetically and sort by county, specialty, or distance from your address.
When you've narrowed your search, start calling the providers you've chosen and asking questions. Try to find a provider who's a good fit for you - someone you're comfortable with and relevant to your specific needs. This is one time you shouldn't worry about considering gender, age, religion, cultural background, or anything else. If it's important to be able to trust the person you choose, it's fair game. Questions you may ask include:
- Where did this provider get his or her training? How long has he or she been in practice?
- What are his or her office hours? How long are sessions, and how much do they cost? Also, be sure to confirm Humana participation - sometimes a provider will change the coverage he accepts but forget to mention it to the insurer.
- What kind of treatment approach does this provider use?
- Does he or she have a specialization of any kind? Some providers work mainly with adolescents or children, some with people who have eating disorders, some with childhood or adult ADHD, and so on.

Whatever you do, don't feel locked in with a provider you aren't comfortable with. On the one hand, you do want to stick with a treatment plan long enough to see if it's going to help - drug therapies, for example, can take weeks to reach their full effectiveness. On the other hand, if you're uncomfortable with the person you've chosen, you're not going to be able to trust that person well enough to make your treatment successful.

The bottom line

Someone once said, "Therapy is like vitamins for your soul." It's important to remember that everyone can use a hand at some point, and it's important to ask when you need help, whether it's for a really big issue or getting over a "road bump" in your life.

Even more, it's important to know what's available to you and how to get what you need - before you need it.

For more information

About specific mental health needs:

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