Hello! My question is how is inpatient mental health care funded in the USA?
Posted by Extension_Pea_8021@reddit | AskAnAmerican | View on Reddit | 63 comments
In the UK, some people choose to go to an NHS hospital voluntarily (if mental health services agree they need to), or involuntarily under the Mental Health Act (known as being "sectioned"), or can access a private mental health hospital if they pay for it. NHS mental health hospitals are funded by national insurance. How does this system work/fund itself for Americans who are admitted to hospital against their will, and are they somehow charged for this? Thanks!
LetterheadClassic306@reddit
in the us it's mostly through insurance - private or government like medicaid. if someone is involuntarily committed they still get billed unless they qualify for medicaid or are in a state funded bed. some states have charity care or mental health levies that cover uninsured people. the system is messy tbh. you can be charged thousands even if you didn't choose to be there. depends entirely on the state and hospital.
thingsbetw1xt@reddit
The patient/patient's insurance pays for it. Yes, that is as dangerous as it sounds, because as with any other healthcare insurajce companies can just refuse to pay for whatever they feel like.
Extension_Pea_8021@reddit (OP)
:(
thingsbetw1xt@reddit
A crazy example of this issue that I just thought of is that of Andrea Yates. Many people are familiar with the fact that she drowned her children, some of those will know it was related to postpartum psychosis. But one thing that gets left out is that she had an extensive history of requiring inpatient mental care, and she was actually turned out and thus forced to quit a treatment that was working for her because her insurance would only cover it for a certain length of time. She was discharged a month before she killed her children.
Royal_Annek@reddit
The patient is billed, usually to their insurance, or parent's insurance.
Extension_Pea_8021@reddit (OP)
Thanks Royal_Annek - what happens to those who dont have insurance?
GiraffesCantSwim@reddit
In my experience, they sign you up for Medicaid if you aren't already. The unit I was in had very few of us on private insurance, everyone else was on either Medicaid or Medicare.
Extension_Pea_8021@reddit (OP)
Thank you - hope all of you are doing well now!
buzzybody21@reddit
This presumes that person lives in a state that expanded Medicaid. Many did not, and so wouldn’t qualify unless they received federal disability (SSI or SSDI), were pregnant or a disabled child.
o93mink@reddit
Keep in mind this is only 8% of the population
Extension_Pea_8021@reddit (OP)
Lower than I thought - thanks
jc8495@reddit
The bill is sent to collections and the patient is supposed to pay it themselves. Doesn’t always happen though because medical bills in this country can be life ruining
kamasutures@reddit
Yep, just duck and dodge collections calls for a couple years and you are in the clear!
Sabertooth767@reddit
(Assuming they don't sue you for it, which is fairly unlikely but not impossible)
reichrunner@reddit
Also fairly unlikely that collections would get a judgement against you for medical debt even if they decided to sue, but you have to make sure you respond and show up to court! You can ignore the debt collectors but you cannot ignore the court case!
Extension_Pea_8021@reddit (OP)
As it would become contempt of court/affect criminal record?
reichrunner@reddit
Generally no. Instead you will get a default judgment against you, which means the court gives the collection agency (or whoever is suing you) whatever they're asking for. So what likely would have been dismissed or at least greatly diminished if you had gone to court, now instead is due in full. If you dont pay it then they can garnish your wages (usually around 10% of your pay), keep your tax returns, and keep any other money that goes through the state
beenoc@reddit
If you ignore the court case, you lose by default, and now it goes from "party X wants money from person Y" to "the government has officially declared that person Y needs to give money to party X, and they can garnish wages and seize property to make that happen if needed."
MyUsername2459@reddit
If they're impoverished, and it's expected to be a long-term commitment, they may enroll them in Medicaid. . .which is the government-run health insurance program for the poor and disabled.
Otherwise, they will probably just get a large bill, that will eventually go to outside bill collectors. Some states have protections against bill collection activity for medical debt in various forms (in my state, as long as you're literally paying ANYTHING on that bill, they can't send it to outside collections or file a lawsuit to get a judgement for collection, so some people will literally send them $1 a month on gigantic bills).
Extension_Pea_8021@reddit (OP)
Ah thanks that makes sense. Does medical debt impact on credit rating?
rhinocerosjockey@reddit
Yes. Trump rolled back the Biden-era law that now allows musical debt to impact your credit score again.
benkatejackwin@reddit
I like the idea of musical debt.
rhinocerosjockey@reddit
lol, you know, I’m going to leave that.
Extension_Pea_8021@reddit (OP)
Musical debt sounds wholesome and easier to repay :)
MyUsername2459@reddit
Currently, yes.
For a few years it didn't, due to a Federal regulation that was enacted in the Biden Administration.
Repealing that rule was one of the early things the Trump Administration did. Presumably the next Democratic administration will reinstate the rule.
QuigonSeamus@reddit
A few things could happen. Whatever time you spent there you will likely be billed for, but once they figure out you don’t have insurance you won’t be there for a long stay regardless. They will put you out as soon as they can justify your safety in the most loose way. Long term treatment is not guaranteed to people who show they cannot pay for services. Mental illness levels are high amongst homeless and prison populations partially for this reason. If you don’t pay the bill they’ll put it through collections. For it to harm your credit and some harsher ways of collecting the bill, your debt will be sold to a third party that is able to come after you more than a medical facility/provider directly. You can generally settle for a lesser amount after that with collections, if you have the means. If not you just keep ignoring it while your credit is ruined, making emergency funds, jobs and housing harder to achieve. It’s an extremely predatory system.
Extension_Pea_8021@reddit (OP)
Ah this sounds very stressful at a time which is already hard for the patient. Thanks for your answer
Sabertooth767@reddit
There's an interesting legal issue surrounding implied consent and billing. While consent to be treated is not consent to be billed absolutely anything, providers still have the right to be compensated for their services.
However, defining what a "reasonable" bill is has proven... challenging, due to the utter lack of transparency from providers (not entirely their fault, but largely their fault).
Extension_Pea_8021@reddit (OP)
Thanks - are there any issues getting insurance for people with a mental health history? I imagine it could affect their premiums?
Good point re providers...I have heard sometimes the bill itself is changeable depending on whether the patient has insurance (?)
Classic-Push1323@reddit
No, that is no longer legal.
Workplace and private plans also aren’t likely to apply to this situation. Many people with severe mental health issues are legally disabled and eligible for a government insurance program and income. If someone is involuntarily committed they are probably not able to work, at least for a time. Hospitals have social workers and can help you apply for these programs. They want to be paid and they know they can’t get more from you if you don’t have it.
If the patient is a teenager or young adult they may be covered by their parents’ insurance or a student insurance plan from their university.
Less than 8% of Americans are uninsured, and a lot of them are healthy young adults who choose to pay out of pocket for routine medical care. A lot of people just don’t pay hospital bills. The hospital is legally required to treat them, and medical debt is often written off.
GiraffesCantSwim@reddit
Mental illness or other issues would be considered a preexisting condition. The ACA made it so insurance companies aren't allowed to refuse coverage based on preexisting conditions.
If that has been weakened or changed by two Trump terms and a whole lot of Republicans acting like people dying in the streets would be fine with them, I don't know. I hope not.
reyadeyat@reddit
As it stands at the moment, that has not been weakened.
GiraffesCantSwim@reddit
I'm pleased to hear that.
Sabertooth767@reddit
One of the things the Affordable Care Act (ACA, "Obamacare") did was ban insurers from discriminating based on pre-existing conditions. So no, they do not pay higher premiums, everyone does. Whether you think that's worth it depends on your flavor of politics.
Yes, an Explanation of Benefits typically has three billing lines: the amount billed (what the provider requested), the amount allowed (what the insurer agreed to), and the patient responsibility (what you owe). These can vary by orders of magnitude; that $1,200 -> $90 was something that actually happened to me, and my share was $0.
danhm@reddit
To make it even crazier its usually something like they take $90 from one insurance company, $350 from another, and somehow only $27 from yet another.
Justmakethemoney@reddit
And even if you have good insurance, you will most likely still get some kind of bill.
My sister had very good insurance, had some mental health issues......and 2 involuntary hospitalizations. Lots and lots of medical bills, lots and lots of stress over money and said medical bills (because she was on leave from work, so no paycheck).
Made things worse.
Extension_Pea_8021@reddit (OP)
Hope things are going better now for your sister - really tricky impact on finances especially when not able to work due to condition
back-better007@reddit
Obamacare made insurers cover mental health, previously it was often excluded. And getting someone admitted for residential treatment is impossible; those are the mentally ill people living on our streets
the_cadaver_synod@reddit
It isn’t impossible, it’s just difficult. Usually the people who end up getting committed under a court order are people who have family members willing to go through the process. I’ve personally known two people who have had this happen (one with extremely severe anorexia nervosa, one with unmanageable schizophrenia), but their families had the resources to manage the legal process, provide medical records, etc. The mentally ill people living on the street simply lack these external influences, and sadly end up cycling in and out of jail or prison.
Classic-Push1323@reddit
I also know people who were committed due to family care & pressure. Just chiming in to support this.
One of those people was arrested for trespassing. His family had to track him down and hire a lawyer to get him out of jail and into a hospital. Without them he’d likely have been treated in prison or a state hospital. He was a good guy, just very sick at the time.
Extension_Pea_8021@reddit (OP)
Yeah sadly the UK definitely isnt foolproof - homeless people with mental health issues are apparent here too and can definitely go under the radar
LastCookie3448@reddit
If you don’t have insurance you’re shit outta luck. If you’re on Medicare, you’re shit outta luck. If you’re on Medicaid, good luck. For every one patient I have in need of a bed, there are at least 100 others in need.
Donald_J_Duck65@reddit
It is billed to the persons insurance company. If your insurance won't cover it, you can enter a state run facility, and the state will cover it.
judgingA-holes@reddit
My mother has severe mental illnesses, and she's on disability for it which means she gets medicare. She has had multiple stays in metal health facilities. Thankfully she's never had to pay anything. Unfortunately, that's not the case for a lot of people, and most have to pay for it whether they wanted to be there or not.
Extension_Pea_8021@reddit (OP)
Hope your mum is doing okay at the moment and thanks for sharing
judgingA-holes@reddit
She is doing well considering everything she's got. Thank you :)
Total-Improvement535@reddit
Say I was in a highly emotional state and authorities thought I needed to be admitted. They would find the closest mental health facility, take me there, and admit me. I would do the things needed to be released and show I am in good mental capacity.
The facility adds up the total amount of my care, we’ll say it’s $100 (even though it would be thousands), and send that $100 bill to my insurance. My insurance says “Well pay $25 of it.” and they pay the facility $25 directly. The facility then mails me an invoice showing everything I was billed for, what insurance paid of it, and gives me options on how to pay the remaining $75.
This is how most health procedures are paid for. The only difference is you usually aren’t charged your co-pay if you’re being admitted like how you would be if it was an out-patient situation.
GiraffesCantSwim@reddit
Except if by "authorities" you mean "police", they will take you to a regular hospital ER for an exam and a hold of some amount of hours (24-72). Then the medical professionals will decide if you are a danger to yourself or others. If you have a partner/parents/etc., they may want to talk to them to find out what's been going on with the patient. If this behavior has been happening for a while, increasing, just started out of nowhere, etc.
If the patient calms down, answers questions thoughtfully and in what seems to be a truthful manner, they may be sent home with a shrug and a "he seems ok". Even though that patient was in the middle of a bipolar episode that was becoming a psychotic break.
Or that's how it is where I live. Even if the parents beg the hospital to keep him, if he's over 18 and wants to leave, they'll let him.
Extension_Pea_8021@reddit (OP)
Can be similar in UK sometimes sadly, unless there is a really thorough mental health assessment team and a lot of background info. Police in UK can't admit to ER, they have their own sectioning powers instead. Thanks for the info
GiraffesCantSwim@reddit
As the parent of a bipolar kid, it has been a wild ride. I'm so happy to report they're stable now but it took a lot to get there.
Extension_Pea_8021@reddit (OP)
Pleased they are doing well - bipolar can really take its toll
Total-Improvement535@reddit
“authorities” wouldn’t mean police in this situation, it would be the doctors, who are an authority in this case, deciding someone needed to be admitted
GiraffesCantSwim@reddit
Ah, gotcha. "Authorities" is such a vague term, but I see it most applied to law enforcement. Sorry for the info dump.
xnatlywouldx@reddit
In an extremely, unbelievably over the top predatory way.
Extension_Pea_8021@reddit (OP)
:(
mmbg78@reddit
I went to the Priory on private insurance...much nicer than any facility I've seen in US
iuabv@reddit
You get billed for it. What is actually covered is about the same as what you would get in the UK, maybe a touch better because there's less of a provider shortage. The quality of care would be much more variable though because it's a less centralized system. It wouldn't be solely tied to how "good" your insurance is either, it would almost come down more to luck and what's in your area.
The threshold to being involuntarily hospitalized is pretty high, so unless your insurance is really really terrible, it's probably going to be mostly covered.
And ironically because insurance is such an annoyance for practicing mental health professionals, working in-patient settings can be preferable for providers.
People who are older or low-income would have access to covered healthcare via Medicare/Medicaid, and the hospital has a vested interest in helping say an unhoused person get on those programs if they're entitled to be, because they want to get paid.
Extension_Pea_8021@reddit (OP)
Ohh thats a good point regarding incentive to get vulnerable people onto relevant programs, and yes we do have MH bed shortages in the UK - these are usually resolved by using leave beds but can lead to early discharge of people who are not really entirely ready to be out. Thanks!
DrBlankslate@reddit
Yep, you get billed for it and you'd better hope you have insurance that covers it, or you'll be paying out of pocket for the rest of your life.
manicpixidreamgirl04@reddit
insurance pays for it
JasminJaded@reddit
Same as all other medical treatment. Insurance pays some, patient pays the rest. In the case of no insurance, “the rest” is the whole bill.
the_cadaver_synod@reddit
If someone is involuntarily hospitalized and is uninsured, they will likely have a social worker help them apply for state-funded insurance (Medicaid). Whether or not they qualify is up in the air.
AshleyHappensTo@reddit
It’s often hard to get covered as insurance doesn’t see it as “health care.” It really varies based on your provider and plan but some cover mental health in full, or not at all. It’s a huge range. Mine used to be free now it’s $100 per session. Also there can be a cap so they may only cover some things or only up to a certain number of sessions.