Getting coverage for mental disorders can be difficult, depending on the insurance company. Many health insurance providers treat mental disorders as pre-existing conditions or simply deny all claims related to a mental disorder. Unfortunately, medication is often treated the same way. Anti-depressants such as Prozac are seen as a high-risk factor that could lead to expensive claims later on. This means that people with bulimia, panic disorder, depression, and pre-menstrual dysphoric disorder must pay the bulk of their medical expenses out-of-pocket. Many insurance companies do not offer any form of mental health coverage, and those that do charge exorbitantly high rates. If you need treatment for any kind of mental disorder, you will need to be patient and persistent.
Before doing anything else, you will need to find out whether your insurance plan offers mental health coverage. If you are specifically interested in Prozac coverage, you will need to read through your contract. Your policy’s schedule of benefits will give a complete list of the types of procedures and conditions covered by your insurance. The section called limitations and exclusions will outline the types of procedures that your insurance provider will not treat under any circumstances. Specific types of medication may or may not be listed; if you do not see Prozac on the list, you will need to call your insurance company.
If you need to appeal, make sure to consult your policy for the correct procedure. Health insurance companies are very picky and might reject an appeal without looking at it if you do not follow the proper form. Enlist the help of your doctor. He or she will be happy to help if it means that your condition will improve. Ask him or her to write you a complete testimonial that states the nature of your condition and why Prozac should be a key part of your treatment.
If you have a group insurance plan, you will be happy to know that the first of several major reforms will expand your existing mental health coverage. The Mental Health Parity and Addiction Equity Act of 2008 requires group plans with existing coverage for mental disorders to provide benefits equal to those provided for other conditions. This means that your insurance company will charge you a lower deductible and allow you to receive treatment with greater frequency. Companies might still refuse to cover certain drugs, such as Prozac, but this law is a step in the right direction.
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