Adolescents are facing significant stress: dealing with difficult social situations, changing bodies, and increased academic pressure. This time of significant growth and change can lead to symptoms of things like depression and anxiety. In fact, one in four to five teens meets the criteria for a mental health diagnosis.1
As a parent, it can be difficult enough to see your child struggle emotionally, and perhaps you’ve realized it’s time to seek out professional help. But it’s also often challenging to navigate mental health coverage for teens. Luckily, coverage has improved significantly in recent years.
In the past, insurance companies didn’t cover the treatment of mental illness in the same way they did physical illness. Whether they denied coverage more often or applied additional fees or deductibles, accessing mental health care proved challenging for many. That’s where California mental health laws come into play.
Youth mental health care in California can feel complicated, but Mission Prep Healthcare is here to make the process of getting your child the help they need as simple as possible. This post will explore what’s covered, the differences between therapy and psychiatric coverage, and how to find covered therapists for teens.
Mission Prep Healthcare specializes in mental health treatment for teens aged 12-17, offering residential and outpatient programs for anxiety, depression, trauma, and mood disorders. Our therapies include CBT, DBT, EMDR, and TMS, tailored to each adolescent’s needs.
With a structured, supportive environment, we integrate academic support and family involvement to promote lasting recovery. Our goal is to help teens build resilience and regain confidence in their future.
Changes in California Mental Health Parity Laws
In 1999, the first California mental health parity law was enacted, guaranteeing coverage of diagnosis and treatment of severe mental health concerns in a comparable way to physical illness.4 However, this left many children with moderate to mild symptoms without the care they needed due to denials for medical necessity.
In 2021, a new law was passed to ensure that youth mental health care in California is covered without differences in financial requirements or specific treatment limitations.4
While this new law aims to improve access to treatment, these changes may still leave parents with many questions as they try to understand the mental health care system. How do I know what’s covered? Does insurance cover teen therapy in California?
To help parents navigate the system, the following section provides guidance for accessing teen mental health care.
Parental Guidance for Accessing Teen Mental Health Care
It can feel overwhelming to figure out how to find the right mental health care for your child. With the expansion of California youth mental health services coverage, there is a wide variety of options, and it can feel difficult to know which is best.
In general, partnering closely with a clinician to discuss what will be most beneficial is important. But to help bridge the gap, in this section, we will discuss the types of care available so you can make informed decisions.
Types of Youth Mental Health Treatment Covered
California laws on teen counseling coverage require a vast range of treatment from outpatient counseling to residential treatment for mental health diagnoses. There are many types of youth mental health treatment covered, so it is important to partner with a provider to determine what level of treatment is most appropriate.
For instance, your provider may recommend talk therapy, such as cognitive behavioral therapy (CBT), to help a teen identify and challenge cognitive distortions that lead to issues like anxiety and depression. Alternatively, if they’ve experienced trauma, eye movement desensitization and reprocessing therapy (EMDR) may be a more appropriate fit. Or, if they’ve tried treatments in the past without much improvement, transcranial magnetic stimulation (TMS) may be recommended.
As long as your provider deems the treatment to be medically necessary, your insurance should cover it.
Differences Between Therapy and Psychiatric Coverage
People often use the terms “therapist” and “psychiatrist” interchangeably, but the two types of clinicians serve different purposes.
A therapist engages in talk therapy to help a client develop healthy coping skills, dismantle harmful thought patterns, and work through life situations. Depending on the severity of symptoms and how effective therapy is, a psychiatric evaluation might be recommended. In this case, a psychiatrist might recommend medications to help manage symptoms.
Medications can be helpful when needed, but usually it is recommended that medication be taken in conjunction with therapy to help mitigate symptoms and develop coping skills.5
In a team approach, the therapist and psychiatrist will collaborate to find the right treatment to help your child increase their well-being. Under the California mental health parity laws, both types of services are covered if they are deemed medically necessary by the provider.
California Behavioral Health Parity
Teen therapy insurance coverage can be tricky. Often, insurance companies deny claims, or you’re met with unexpected costs from deductibles, copays, and coinsurance. Knowing the insurance rules for adolescent mental health treatment can help you ensure that you’re doing right by your teen while also using your benefits to their fullest potential.
Your Rights Under California’s Mental Health Parity Act
The impact of parity laws on teen treatment access has been beneficial for adolescent mental health care. Yet, while accessing mental health care for teens is much easier, navigating insurance approval for teen therapy can still be difficult. For instance, in many situations, mental health treatment coverage is often denied.
In addition to the right to coverage for services comparable to medically necessary treatment for physical illnesses, you have the right to appeal denials. If coverage is denied, it’s important to ask for the reason why, and your provider can often provide more information to appeal the denial.3
Our insurance verification team at Mission Prep Healthcare can make the process much easier. We can help you use insurance for teen counseling and understand mental health parity laws for youth to appeal denials.
What if My Child’s Coverage Is Denied?
It can be incredibly frustrating when an insurance claim is denied for services your clinician recommends. If this happens, contact your provider to see if they can provide additional information for the claim and see if it is accepted.
You can also file an appeal or grievance with the health insurance company. When you receive an explanation of benefits, the insurance company provides a reason for denial, which can help you determine the course of action. Often, this means reaching out to your provider for additional information.
Once you file an appeal, the insurance company is expected to make a decision within 30 days based on California law. However, if the matter is urgent, you can request an expedited review within 72 hours.6
It may help to know that it is common for claims to be initially denied but later accepted with more clinical information. You can also reach out to our team, as we can help you navigate any coverage denials to make care as seamless as possible.
Mission Prep’s Commitment to Your Care
At Mission Prep Healthcare, we know how hard it is to even take the first step in getting help. Whether you’re looking for help for a teen with anxiety, depression, technology dependence, or any other mental health condition, our team of clinicians is ready to assist.
We offer many modalities of counseling, such as cognitive behavioral therapy, EMDR for trauma treatment, and transcranial magnetic stimulation as a way to help treatment-resistant teens. Meet with a member of our counseling team to determine what would be most beneficial for your teen, and our office will advocate for your family to get the services they need to thrive.
Our insurance verification team also makes the process of seeking treatment as easy as possible. The team will verify your benefits, review your options, and discuss the best course of action without any surprise bills or fees. Some plans may have limits on the number of sessions in a certain time period. However, we will work to maximize your benefits and ensure your child receives the best care possible. We can also help you navigate in-network versus out-of-network benefits, including superbills, which can get you reimbursed for providers who are not in your plan.
Mental health is just as important as physical health, and the California mental health parity laws are now acknowledging that. No matter your child’s needs, there are options to help them feel better. Whether you’re seeking outpatient talk therapy, intensive outpatient, or our residential treatment program, we can help you navigate the healthcare system to get your child the help they need.
References
- California State Legislature. (2020). Senate Bill No. 855: Health coverage: Mental health or substance use disorders. https://leginfo.legislature.ca.gov/faces/billTextClient.xhtml?bill_id=201920200SB855
- Merikangas, K. R., He, J.-P., Burstein, M., Swanson, S. A., Avenevoli, S., Cui, L., Benjet, C., Georgiades, K., & Swendsen, J. (2010). Lifetime prevalence of mental disorders in U.S. adolescents: Results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A). Journal of the American Academy of Child and Adolescent Psychiatry, 49(10), 980–989. https://doi.org/10.1016/j.jaac.2010.05.017
- Peck, M. C. (2001). State health care reform: Mental health parity for children in California. Psychiatric Services, 52(6), 743–768. https://doi.org/10.1176/appi.ps.52.6.743
- Essentials: Understanding mental health parity. (2024, November 14). Steinberg Institute. https://steinberginstitute.org/essentials-understanding-mental-health-parity/
- Ellison, J. M. (2005). Teaching collaboration between pharmacotherapist and psychotherapist. Academic Psychiatry, 29(2), 195–202. https://doi.org/10.1176/appi.ap.29.2.195
- California Department of Insurance. What to Do if You Have a Problem with Your Policy. (n.d.). Www.insurance.ca.gov. https://www.insurance.ca.gov/01-consumers/110-health/30-have/prob-with-pol.cfm
