When you’re struggling with your emotional wellbeing or dealing with substance use challenges, you deserve access to quality care. If you have health insurance, the law protects your right to receive the treatment you need.
Understanding Your Needs
Mental health issues affect many people today. In California alone, roughly 1 in 6 individuals experience some form of mental health concern. Additionally, about 8 out of every 100 people battle addiction or substance use problems. The positive takeaway is that insured individuals enjoy legal protections—both nationwide and in their home states—that ensure they can get the support they require.
Your Legal Protections
Caring for your emotional wellness is just as important as treating physical illness. Both federal and state laws work together to make sure your insurance covers the behavioral health services you need.
What Federal Protections Guarantee
Your mental health matters. The Affordable Care Act (ACA) requires all insurance companies to pay for mental and emotional wellness services. This covers individual therapy, group counseling, inpatient psychiatric stays, and programs for substance abuse recovery. Nearly every insurance plan that meets ACA standards covers all types of mental health conditions and addiction treatment options.
Federal law also demands fairness. Your insurance company must treat mental health benefits the same way they handle medical benefits. This applies to everything—your copays, deductibles, visit limits, and how they approve your care plan.
Extra Help from California
California’s laws add another layer of support. Insurance companies operating in the state must cover treatment for these specific conditions:
- Major depressive episodes
- Autism and developmental disorders
- Bipolar disorder
- Panic attacks and anxiety episodes
- Schizophrenia and similar conditions
- Mixed mood and psychotic symptoms
- Obsessive-compulsive disorder and related conditions
- Anorexia and other eating disorders
- Binge eating patterns
- Serious emotional or behavioral difficulties in children and teens
All of these conditions need quick, expert treatment. Your insurance must pay for doctor’s appointments, evaluations, hospital care, day programs, outpatient services, and prescribed medications—all using the same payment terms as your regular medical care.
A 2021 California law added another protection: after seeing a mental health expert, you must be able to schedule a follow-up visit within ten business days. When your primary care doctor sends you to a specialist, that appointment must also happen within the same ten-day period. This rule went into effect in July 2022.
How to Find and Start Treatment
Beginning your recovery doesn’t need to be difficult. Getting professional help sooner means you can start feeling better faster. Every insurance plan operates slightly differently. Some let you call a counselor directly, while others ask that your family doctor approve a referral first.
Call your insurance company’s customer service team or visit their website to learn your plan’s specific steps. Many companies have a separate phone line just for mental health questions—look for this option to connect faster with someone who can help.
Reach out for support. Professional help exists for you and your loved ones.
Resources to Get Started
Not sure where to begin? The Behavioral Health Treatment Services Locator is a private, safe tool that helps you locate mental health care or addiction recovery programs in your area.
If you’re having thoughts of harming yourself, call or text 988 to reach the National Suicide Prevention Lifeline. This service operates 24/7 and connects you with someone who cares. Think of 988 the same way you’d think of calling 911 for a physical emergency—it’s your crisis support hotline for mental health.
