Therapy can be expensive without health insurance coverage. But taking care of your mental health is important for your overall well-being. The good news is that Amerihealth Pennsylvania insurance plans cover counseling and psychotherapy, making these services more affordable.
Whether you are thinking about therapy for the first time or are already seeing a therapist, this guide will explain the benefits included in Amerihealth plans. You will learn how to keep your therapy costs low by using in-network providers, understand copay and coinsurance amounts, and figure out how many sessions are covered.
All About Amerihealth
Amerihealth is an insurance company that provides quality, affordable health coverage to millions across 15 states. As part of Independence Health Group, they’re one of the major health insurers in the Northeast. In Pennsylvania, Amerihealth offers two main insurance options: Amerihealth Pennsylvania and Amerihealth Caritas Pennsylvania.
AmeriHealth Pennsylvania
AmeriHealth Pennsylvania is a commercial health insurance plan that is offered to individuals and businesses in Pennsylvania. They provide Pennsylvania residents with a wide range of benefits, including doctor visits, hospital stays, prescription drug coverage, and preventive care services.
Amerihealth Pennsylvania has an extensive network of healthcare providers that you can choose from within the state of Pennsylvania.
Amerihealth Caritas Pennsylvania
Amerihealth Caritas Pennsylvania is a managed care health plan that helps those getting Medicaid. They’re committed to making sure that you have access to high-quality, affordable healthcare. The company offers a wide range of services, including:
- Preventive care, such as checkups, immunizations, and screenings
- Primary care services, such as doctor’s visits and prescriptions
- Specialty care services, such as cardiology, oncology, and orthopedics
- Mental health and substance use services
- Long-term care services
Amerihealth Caritas Pennsylvania also offers specialized plans to meet the needs of people who qualify for both Medicare and Medicaid:
- Medicare Dual-Eligible Special Needs Plans (D-SNP) are for people who are eligible for Medicare Part A, enrolled in Medicare Part B, and receiving medical assistance.
- Medicare-Medicaid Plans (MMPs) are for those who qualify for full benefits under both Medicare and Medicaid.
Therapy Coverage for Mental Health Services
Insurance companies have traditionally focused on physical health, but Amerihealth Pennsylvania understand the importance of mental health as well by providing coverage for therapy and counseling services, including substance use disorder services, as well as:
- Outpatient Services: This includes individual counseling, group therapy services, and medication evaluation and management.
- Inpatient Services: For patients who need to stay in a hospital or other healthcare facility for more than 24 hours.
- Tele-behavioral Health: You can have virtual visits with a licensed mental health professional by phone or video chat from home.
- MyStrength Plus: This self-guided online resource offers personalized programs and support for a wide range of topics, including stress, depression, chronic pain, work-life balance, substance use, and anxiety.
Keep in mind that specific therapies covered may vary depending on your specific coverage details. It’s important to check with your Amerihealth Pennsylvania representative to find out what services are covered under your plan.
Therapy Services That Aren’t Covered
Amerihealth Pennsylvania tries to cover most types of therapy, but some are not covered. These include:
- New and untested treatments, medicines, and equipment
- Services that you don’t need for medical reasons
- Long-term inpatient treatment without prior approval
- Services provided by a doctor or therapist who is not in the Amerihealth network, except for:
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- Emergency services
- Birth control services
- Smoking cessation counseling
- Services that have been approved in advance by Amerihealth
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Services not covered can change from time to time, so it’s a good idea to check with customer service to get the most up to date list.
How Do You Find Out What’s Covered for You?
The best place to start is by taking a look at your insurance plan to make sure your policy is active and that you are eligible for mental health benefits. Look for key info like therapy copays, deductibles, session limits, and in-network vs out-of-network coverage. This will help you understand the costs you can expect to pay.
To check your insurance coverage, you have several options:
- Online: Log into your online member account to view benefits info like copays and deductibles. Therapy coverage specifics will be there.
- Phone: Call Amerihealth Pennsylvania customer service at 1-866-681-7373 and tell them you want to learn about your health benefits. They can walk you through it.
- Mail: If you’d prefer to receive a physical copy of your coverage information, you can request it by mail. Contact Amerihealth Pennsylvania customer service and ask them how you can get a printed copy of your coverage details.
If you have any questions or don’t understand something, reach out to customer service and they’ll be happy to help.
What Will Therapy Actually Cost You?
The actual cost of therapy will vary depending on your specific plan benefits and other factors such as your deductible, copay, and coinsurance.
If you have Medicaid, Medicare, or Affordable Care Act (ACA) coverage, you may have more options for affordable mental health services. For example, Medicaid covers most mental health services, and Medicare covers mental health services provided by psychiatrists and other qualified mental health professionals.
Here’s a breakdown of some of the key terms you may see on your insurance plan that can affect how much your therapy will cost:
Plan Type
This tells you what kind of insurance plan you have. Each type of plan has its own rules about which providers you can see and how much you have to pay for services.
In-Network vs. Out-of-Network
In-network therapists have contracts with Amerihealth Pennsylvania, which means they charge less. Out-of-network therapists don’t have these contracts, so they may charge more. Choosing an in-network therapist can save you money. Some plans don’t even cover out-of-network services, so be sure to check with Amerihealth Pennsylvania before you choose a therapist.
Find an in-network therapist
Deductible
Your deductible is the amount of money you have to pay out of pocket before Amerihealth Pennsylvania typically starts covering your therapy costs. For example, if your deductible is $500, you will likely have to pay that amount before they will cover any of your therapy sessions.
Copay
Your copay is the fixed amount of money you have to pay for each therapy session. Copays can vary depending on your plan and the therapist you see.
Coinsurance
This is the percentage of your medical expenses that you have to pay after meeting your deductible. For example, if your coinsurance is 20%, you have to pay 20% of your medical expenses after meeting your deductible.
Out-of-Pocket Maximum
This is the maximum amount of money you have to pay for medical expenses in a given year. After you reach your out-of-pocket maximum, your insurance will pay 100% of your covered medical expenses.
It’s important to note that everyone’s insurance plan is different, so it’s always a good idea to check your coverage and contact Amerihealth Pennsylvania if you have any questions.
Get a therapy cost estimate
Finding an In-Network Amerihealth Pennsylvania Therapist
The key to affording therapy is finding a therapist who takes your insurance. Here are some tips:
- Use Amerihealth’s Pennsylvania’s provider directory online and filter for therapists near you or call customer service and ask for in-network recommendations.
- Visit Grow Therapy to view a list of therapists who accept your insurance, are in your area, and meet your other specific needs.
How to Maximize Your Benefits
Here are some tips for making the most of your Amerihealth Pennsylvania therapy benefits:
Understand Your Plan
What types of therapy are covered? How many sessions are covered per year? Do you need to get permission from Amerihealth Pennsylvania before you start therapy? You can find this information on the Amerihealth Pennsylvania website or by calling their customer service line.
Choose In-Network Providers
In-network providers have contracts with Amerihealth Pennsylvania, which means that AmeriHealth Pennsylvania will cover most of the cost for your therapy session. You can find a list of in-network providers on the Grow Therapy website.
Ask Questions
If you have any questions about your coverage or how to find a therapist, don’t be afraid to call Amerihealth Pennsylvania customer service. They are there to help!
Get Pre-Authorization if Needed
Some Amerihealth Pennsylvania plans require pre-authorization for therapy services. This means that you need to get approval from Amerihealth Pennsylvania before you can start therapy. You can get pre-authorization by calling them directly.
Stick with Your Therapy
Therapy works best when you go regularly. Your therapist will determine how often you need to have sessions, typically starting at once a week, but it can vary.
Don’t be afraid to speak up. If you’re not comfortable with your therapist or you’re not getting the results you want, tell them. You can also switch to a different therapist if you want.
Try Online Therapy
Teletherapy or online therapy can be done from home or anywhere else with an internet connection. Many Amerihealth Pennsylvania plans cover teletherapy services. Teletherapy can be a convenient and affordable option for people who have difficulty accessing in-person therapy services.
By following these tips, you can make the most of your Amerihealth Pennsylvania therapy coverage and get the support you need to improve your mental health.
Book a Session Today
Now that you know more about your Amerihealth Pennsylvania therapy coverage, you can make informed choices about your treatment.
Don’t let financial concerns stop you from getting the counseling you deserve. Whether it’s for mental health, substance use, or other behavioral health issues, use your benefits to your advantage and start healing today.
