HMC HealthWorks Insurance Coverage for Behavioral and Mental Health Therapy and Treatment

A MISSION FOR MICHAEL

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With A Mission For Michael (AMFM), you can access top-tier mental health services in California, Washington, and Virginia. Our residential treatment programs utilize evidence-based programs and boast an assortment of holistic and specialized treatment options. We can provide you with a one-of-a-kind treatment experience, tailored to your unique needs.

We provide treatment for a range of mental health disorders, including dual diagnosis conditions. This includes conditions like anxiety, depression, bipolar disorder, schizophrenia, and PTSD (Post Traumatic Stress Disorder). For many, insurance coverage can make accessing mental health treatment affordable and realistic. We want to review commonly used HMC HealthWorks mental health services, and how they can help reduce the costs of therapy and counseling.

Who is the Health Insurance Provider, HMC HealthWorks?

HMC HealthWorks goes beyond the typical boundaries of an insurance company by offering a wide range of health solutions for individuals, employers, and insurance providers. Services commonly covered by HMC HealthWorks include preventative measures and evidence-based approaches to health concerns.

HMC can trace its roots back to 1976, when its founder, Dr. Janis S.DiMonaco, Ph.D., was working as a clinical social worker in Massachusetts. A few years later, she began offering Employee Assistance Programs (EAP) and wellness programs for employers. Since then, HMC HealthWorks has continued to evolve, allowing them to provide a unique assortment of services.

HMC offers a range of services, which can be utilized by those without health concerns, and those living with chronic conditions. HMC can provide you with support and guidance in reaching your wellness goals. Continue reading for an introduction to available programs with HMC HealthWorks:

  • Chronic Care Management: You can receive customized solutions for health conditions including diabetes, coronary artery disease, asthma, chronic obstructive pulmonary disease, back pain, heart failure, high cholesterol, and high blood pressure.
  • Managed Behavioral Health: Available behavioral health services include clinical utilization for higher levels of care, 24/7 access to crisis assessment and triage, appointment assistance, appeal management, provider network, and benefits/eligibility/referral information.
  • Wellness: Available wellness modules commonly include weight management, exercise and physical activity, healthy eating guidance, stress management, smoking cessation, heart disease prevention, and diabetes prevention.
  • Employee Assistance Programs (EAPs): An EAP offers access to credential providers for employees and their families who are experiencing a range of challenges including mental health concerns, bereavement, marital challenges, legal challenges, and financial guidance.
  • Opiate and Pain Management: This program focuses on reducing the impact of opioid abuse. This includes effective assessments, outreach, and continued monitoring for opioid prescriptions.
  • Value Added Services: Value-added services can vary among members because they are based on your needs. This can include medical/behavioral care management, preventative services, and pharmacy cost containment.

Behavioral health conditions can create challenges in your emotional, psychological, or social well-being. This commonly includes disorders like depression, anxiety, bipolar disorder, and substance use issues. Mental health disorders are considered behavioral health conditions, though they are specifically outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM).

Stress-related problems and co-occurring disorders can also be considered behavioral health conditions. These conditions commonly affect your thoughts, feelings, and actions which can impact your relationships, work, and daily functioning. For many, psychotherapy can help you learn effective self-care and coping strategies to manage your symptoms. Treatment can include individual therapy, support groups, and psychiatry services.

Treatment options for mental health disorders can vary in intensity, duration, and in the approaches used. Mental health conditions are individualized and often respond to varying treatments. Examples of commonly used therapeutic approaches include Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and mindfulness-based therapies.

Those who are experiencing moderate to severe symptoms may require residential treatment or crisis services. Those who experience mild and moderate concerns may not require intensive treatments, and utilize outpatient treatment programs. Having access to both of these options allows you to continuously access treatment during the different stages of your recovery, promoting healing and overall emotional well-being.

In 2021, an estimated 57.8 million U.S. adults, or 22.8% of the population, were living with a mental illness. Of these, 5.5% were managing severe mental health conditions, according to the National Alliance of Mental Illness (NAMI). These challenges can impact your daily life, including careers, relationships, and the ability to manage routine tasks effectively.

Regional trends highlight variability in mental health statistics. California reported lower rates of anxiety and depressive disorders than the national average in February 2023, though its age-adjusted suicide rate in 2021 was lower than the U.S. average. In contrast, Washington State showed slightly higher rates of anxiety and depression, with a higher suicide rate in 2021. Meanwhile, Virginia reported lower rates of anxiety and depression in 2023, though it faced higher opioid overdose rates. Access to private insurance varied, with 55.3% coverage in Washington and 64% in Virginia, reflecting above-average coverage nationally.

How To Check Your HMC HealthWorks Insurance Coverage at AMFM

To learn about the details of your HMC HealthWorks insurance coverage, we encourage you to complete the AMFM insurance verification form. This provides our admission counselors with the information they need to contact HMC directly and learn about the relevant details of your policy. We will inquire about out-of-pocket expenses, limitations, exclusions, and required prior authorizations.

For further guidance and support, we encourage you to call AMFM Mental Health Treatment Centers today.

Does HMC HealthWorks Cover Inpatient Residential Mental Health Treatment?

HMC HealthWorks mental health insurance often includes insurance coverage for residential treatment programs. This level of care is ideal for those experiencing moderate to severe mental health distress, who require continued support to manage their mental illness. These programs often combine the use of individual, group, and family therapy. Psychoeducation sessions are used to help you understand your mental health.

Your coverage for residential treatment is dependent on the details of your coverage. Your policy may have set deductibles, copayments, and premiums that you’re responsible for. Contact AMFM Mental Health Treatment Centers today for support in understanding your residential treatment coverage.

Does HMC HealthWorks Cover Mental Health Therapy in Outpatient Programs?

Yes, HMC HealthWorks mental health coverage can include outpatient treatment care. Outpatient treatment can provide flexible treatment options, including individual therapy and support groups. You may engage in weekly, or biweekly sessions, depending on your needs. Outpatient clinics may also provide psychiatry services, such as medication management services.

Coverage can vary based on your plan type. The claims process often involves assessing risk for insured individuals. Exclusions and endorsements can impact which treatment services are included in your coverage

Does HMC HealthWorks Cover IOP/PHP Mental Health Therapy Programs?

HMC HealthWorks mental health coverage can also include Intensive Outpatient Programs (IOPs) and Partial Hospitalization Programming (PHPs). These treatment options are ideal for those with mild to moderate symptoms who do not require around-the-clock support. You can learn effective stress management and coping strategies, allowing you to better manage your mental health concerns.

Coverage can vary based on the details of your policy. An umbrella policy can extend your coverage limits, while indemnity allows you to choose from a wider range of treatment providers. Subrogation may be available if a third party is responsible for some of your treatment costs.

Do HMC HealthWorks Cover Mental Health Evaluations and Assessments Near Me?

Yes, HMC HealthWorks mental health insurance typically includes a comprehensive mental health assessment. This is a vital step of the admission process because it allows mental health providers to determine a mental health diagnosis and ideal treatment plan. Assessments will explore your current symptoms, level of distress, mental health history, and other related experiences.

Your plan may have out-of-pocket expenses in the form of copayments, deductibles, and premiums. Contact AMFM Mental Health Treatment Center for guidance and support in understanding your insurance coverage.

HMC HealthWorks Mental Health Providers Near Me

A Mission For Michael is a leading residential treatment provider with multiple treatment locations. Our treatment approach is tailored to each individual, incorporating holistic approaches, wellness programs, and evidence-based approaches. Dial (866)478-4383 to explore available HMC HealthWorks mental health services.

Does HMC HealthWorks Insurance Cover Dual-Diagnosis Treatment Programs?

Yes, HMC HealthWorks mental health insurance coverage can include treatment for dual diagnosis treatment. Dual diagnosis care can occur in both inpatient and outpatient treatment settings, depending on the severity of your symptoms. These are specialized treatment programs that provide treatment for the complex nature of dual diagnosis concerns. 

Dual diagnosis care may require prior authorization. An insurance adjuster will evaluate your claim and compare it to the terms of your policy. They will be looking specifically at exclusions and coverage limits. Proper documentation is vital for settlements.

HMC HealthWorks mental health coverage can include a range of treatment options used to treat co-occurring mental health and substance abuse concerns. Depending on the severity of your addiction, this may include a medically supervised detox, counseling, or medication management services.

The goal of treatment for dual diagnosis conditions is to treat both conditions simultaneously. These conditions are often intertwined and require complex care for optimal growth. You may need to obtain prior authorization, based on the details of your plan.

Dual diagnosis treatment can provide evidence-based care for alcohol use disorder and other mental health concerns. This can include detoxification services, inpatient treatment, outpatient treatment, and continued medication management services. Choosing a dual diagnosis program can help address the underlying connection of your two disorders, supporting long-term recovery.

Your HMC HealthWorks policy may require that you obtain prior authorization, or have exclusions for out-of-network providers.

What Disorders Does HMC HealthWorks Cover for Counseling and Psychiatric Therapy?

HMC HealthWorks mental health coverage encompasses a wide range of mental health conditions and services. This allows policyholders to receive individualized care, based on their unique mental health needs. Continue reading for an overview of some of the conditions and services commonly included in HMC coverage.

HMC HealthWorks Insurance Coverage for Mental Health Assessments and Evaluation

HMC HealthWorks coverage commonly includes assessments and evaluations. In addition to being used during the admission stages of treatment, you can engage in assessments throughout your treatment experience. This can help your clinical team gauge your progress, and make necessary adjustments to your treatment plan.

HMC HealthWorks Insurance Coverage for Psychosis

Psychosis is known for causing symptoms that cause a disconnection from reality. This can include hallucinations, delusions, and disorganized thinking. Psychotic symptoms can occur with mental illnesses like schizophrenia, delusional disorder, and bipolar disorder in some cases. HMC coverage can include psychiatric care, crisis intervention services, and inpatient treatment.

HMC HealthWorks Insurance Coverage for PTSD

Post Traumatic Stress Disorder (PTSD) can develop after a traumatic event. This can lead to symptoms of hypervigilance, anxiety, nightmares, and flashbacks. PTSD can range in severity and can be classified as a disability in severe cases. HMC HealthWorks commonly provides coverage for both inpatient and outpatient treatment options.

HMC HealthWorks Insurance Coverage for Paranoia

Paranoid symptoms can create significant challenges in your day-to-day life, and make it challenging to trust those around you. Paranoia can be a component of several mental illnesses, including paranoid personality disorder, paranoid schizophrenia, and delusional disorder. HMC mental health coverage can include medication management services, inpatient, and outpatient care.

HMC HealthWorks Insurance Coverage for Depression Disorders

Depression and depressive disorders are known to cause a range of symptoms, including a loss of interest, hopelessness, guilt, isolation, and fatigue. These mental health disorders can affect your professional and social life. HMC mental health coverage typically includes depression treatments, such as inpatient and outpatient care, along with medication management services.

HMC HealthWorks Insurance Coverage for Trauma

The World Health Organization (WHO) indicated that 70% of the world population will experience trauma during their lifetime. Trauma can affect your mental health, leading to symptoms of depression, anxiety, isolation, and more. HMC HealthWorks can provide you with coverage for a range of treatment options, including psychotherapy and medication management services.

HMC HealthWorks Insurance Coverage for Anxiety Disorders

Anxiety disorders are known for creating a persistent sense of worry, anxiety, and panic in some cases. Anxiety symptoms can be triggered by situations, like public or social settings. These are the most common mental health conditions in the U.S. and respond well to treatments like CBT and exposure therapy. Insurance coverage often provides coverage for appropriate treatment options.

HMC HealthWorks Insurance Coverage for ADHD

Attention Deficit/Hyperactivity Disorder (ADHD) is a condition that develops in childhood and can continue into adulthood. You may struggle with focusing, remaining motivated, sitting still, and interrupting others. ADHD can affect your work performance and relationships. HMC HealthWorks often provides coverage for members who are struggling with ADHD.
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    Find out about our free assessments and admissions process

    We accept most major insurance providers and can check your coverage levels for you.

    If we are not an appropriate provider for care, we will assist in finding a care provider that can help. 

    Which Therapies Are Covered By HMC HealthWorks Insurance Plans?

    Your HMC HealthWorks mental health coverage can include an assortment of mental health services. This allows you to access personalized care that helps you develop the skills and knowledge needed to manage your mental health symptoms. Examples of commonly approved treatments and therapies for HMC policyholders include, but are not limited to:

    Psychodynamic therapy focuses on exploring how your unconscious thoughts and previous experiences are contributing to your current mental health challenges. This can be an effective treatment for anxiety, depression, and unresolved trauma. With this approach, you’ll develop a strong, and safe, therapeutic relationship that allows you to explore emotional challenges and learn effective coping strategies.

    Family therapy can be an effective treatment option for families that are navigating a mental health concern, medical condition, or unhealthy relationship dynamics. Family therapy sessions can focus on effective communication patterns, psychoeducation, strengthening bonds, and establishing trust. They can also address unhealthy relationship patterns like codependency and enabling, often seen with addictions.

    Dialectical Behavior Therapy (DBT) is a therapeutic approach that introduces you to mindfulness practices, emotion regulation, and distress tolerance skills. It can also help you strengthen your interpersonal relationships. DBT is commonly used to treat borderline personality disorder, intense mood swings, and self-harming behaviors. It can be used in both inpatient and outpatient treatment settings.

    Combining mindfulness practices with CBT principles, MBCT can be an effective treatment option for anxiety and depression. You’ll learn to increase your self-awareness by staying in the present moment and not getting lost in your anxious or depressive thoughts. You’ll also learn to challenge negative thought patterns that contribute to the mental health challenges that you experience.

    Cognitive Behavioral Therapy (CBT) is one of the most commonly used approaches in therapy and counseling sessions. CBT focuses on helping bring your attention to unhealthy thoughts and beliefs that contribute to your mental health difficulties. This approach can be used to treat anxiety, depression, post traumatic stress disorder, and various substance abuse concerns.

    Group therapy is a commonly used treatment service for a range of mental health conditions. This includes grief, anxiety, depression, and more. Group therapy allows you to connect with others who relate to your mental health symptoms and personal experiences. This can be a validating and healing experience, and help you learn how to cope with the psychological distress you experience.

    How Much Does Mental Health Treatment Cost With HMC HealthWorks Insurance?

    The cost of mental health treatment is generally more affordable with the use of insurance. Coverage can account for some, if not most, of the costs associated with various mental health treatments. You may be responsible for a small portion of fees, such as premiums, copayments, and deductibles.

    We encourage you to verify your insurance coverage to learn about limitations or exclusions associated with your plan so that you can choose a healthcare provider appropriately.

    Psychiatrist writing notes while having therapy session with a patient.

    How Much Do Behavioral Health Therapy Programs Cost Without HMC HealthWorks?

    The cost of mental health treatment can vary among different treatment programs. Inpatient treatment programs cost between $500 to $2,000 per day. This cost can fluctuate based on the duration of care, services you receive, the location of your provider, and the experience of their staff. High-end treatment facilities often have higher costs due to the amenities available to them.

    Traditional outpatient therapy sessions cost between $100 to $200 for individual sessions and lower costs for outpatient treatment. Intensive outpatient programs, like partial hospitalization programs and intensive outpatient programs, have higher costs. This is due to the intensive nature of the care they receive. For a personalized quote regarding mental health treatment, we encourage you to contact AMFM by calling (866)478-4383 and speaking with an admission counselor.

    How To Get HMC HealthWorks To Pay For Mental Health Therapy at AMFM

    Verifying your HMC HealthWorks insurance is a critical step in ensuring your mental health treatment is covered. This process brings our attention to any limitations, exclusions, or authorizations needed. At AMFM, we assist you in completing the necessary paperwork for a smooth insurance claims process.

    HMC HealthWorks insurance plans typically cover various evidence-based therapies, including inpatient and outpatient care. Understanding your policies can help you choose a treatment program that aligns with your policy and treatment needs.

    The length of treatment covered by HMC HealthWorks depends on your specific mental health symptoms and the details of your policy. You may need to demonstrate that your planned treatment is medically necessary, especially for policies with session limits. Some HMC policies may have set session limits, but you can inquire about prior authorizations in some cases. 

    Your policy might outline coverage limits for programs like inpatient and intensive outpatient treatments, like PHPs and IOPs. Contact AMFM today for help understanding the scope of your HMC HealthWorks insurance plan.

    Coverage limitations for treatment episodes may vary for HMC HealthWorks policyholders. Many plans allow multiple treatment episodes per year if deemed medically necessary. This can include inpatient programs, outpatient services, or a mix of both. Restrictions may apply to a set number of therapy sessions or inpatient days each year.

    However, you may request extensions or prior authorizations for additional coverage if your mental health symptoms require additional support. AMFM admission counselors are available to help you navigate your coverage details and assist with requests for treatment beyond policy limits. Call us today for support and guidance.

    • The HMC HealthWorks website indicated that over one year, a client can experience $1.3 million in savings, which equates to a 3.7 Return on Investment (ROI).
    • HMC HealthWorks was acquired by Uprise Health in February 2021.
    • The National Institute of Mental Health (NIH) indicated that about half of adults living with a mental health disorder in 2022 did not engage in mental health treatment.
    • A survey completed by Mental Health America indicated that treatment costs are a significant barrier for Americans experiencing mental health distress.
    • The United States Census Bureau indicated that 65% of Americans have private health insurance, which is more prevalent than those with public coverage.

    Check if your health insurance will cover the cost of mental health treatment.