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Does Mental Health Insurance "Cap" or have a limit per year? Can mental health turn over into Major medical?

I know a woman who is chronically in the psychiatric hospital for suicidality. For those mental health aware---she is more than likely a very low -functioning borderline. Within the last 12 months, she has spent about 17 weeks total on a locked Inpatient unit. Working in mental health myself (though not in insurance) I know the cash-value (so to speak) of an inpatient stay is about $1000 per day. Obviously, I am sure the contracted rate is much less... anyway. After being released one week ago, she is voluntarily checking in again this evening. I am sort of shocked she has enough insurance coverage to continuously be re-admitted inpatient. Do the number of days allowed "start over" with each new admission? Either that, or I would have to think that Major Medical kicks in. I am very surprised the insurance continues to cover her, when they are in essence "losing so much money" on this patient---with very little results. For my own understanding, I would like some insight into this.

Public Comments

1. Yes, there's a cap. No, it doens't convert to major medical. She might NOT have enough coverage, most policies limit you to 30 days a year, and many have a 30 day LIFETIME limit. My guess is, she's racking up the bills, and there either isn't any insurance covering this, or she's getting a state bed - where the taxpayer is covering this.
2. It depends upon her specific policy. I've seen policies that have a cap on mental health. (And that cap can vary - can be based on the number of days/visits, based on the number of admissions per year, or capped on a total dollar amount. Just depends on how her specific policy would be spelled out.) However, I've also seen policies that don't have a cap at all. Also, its possible that her going back within a week of getting discharged isn't considered a "new admission." (I've seen policies set up where if you are re-admitted within X number of days its not considered a "new admission.") In her case, I would suspect that she has a policy that either doesn't have a cap, or that has a case management benefit. (Case management = a nurse from the insurance company and the medical provider negotiating a special rate/terms for a patient who is an outlier...falls outside the scope of the regular benefits.) If she's staying inpatient, her insurance company is likely pre-certifying each of her admissions, and also likely re-certifying her need for being inpatient periodically throughout each of her stays.