Insurance

Your Evernorth Therapy Coverage, Explained

It is important to prioritize mental health and therapy, as they play a crucial role in overall well-being. However, many people struggle to find affordable therapy services that can meet their needs. This is where Evernorth Insurance, a leading healthcare services company, comes in. Keep reading to learn what mental health services are covered by […]

derek lee grow therapy By Derek Lee, VP of Insurance Operations

Updated on Jan 12, 2024

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It is important to prioritize mental health and therapy, as they play a crucial role in overall well-being. However, many people struggle to find affordable therapy services that can meet their needs. This is where Evernorth Insurance, a leading healthcare services company, comes in.

Keep reading to learn what mental health services are covered by Evernorth, how to check your benefits, and where to find an in-network therapist.

What Is Evernorth Insurance?

Evernorth Insurance stands out from other insurance providers through its commitment to whole-person health, which encompasses both physical and mental well-being. While many insurance providers focus primarily on physical health, Evernorth Insurance recognizes and prioritizes the importance of mental and behavioral health in achieving overall wellness.

Evernorth Insurance offers a wide range of health plans and services that are designed to take a comprehensive approach to health and well-being. This means that members can expect coverage and support for not only physical ailments and conditions but also for mental health concerns and therapy needs. By recognizing the interconnectedness of physical and mental health, Evernorth Insurance strives to provide a holistic approach to care.

Moreover, Evernorth Insurance goes beyond just acknowledging the importance of mental health by actively integrating mental health coverage into its health plans and benefits solutions. This means that members have access to various mental health services, including therapy, counseling, and treatment options. By including mental health coverage as an integral part of its offerings, Evernorth Insurance ensures that members receive the support they need for their mental well-being.

Does Evernorth Insurance Cover Mental Health Therapy?

Evernorth Insurance provides behavioral health services through its case management programs, Employer Access Programs (EAPs), and concierge behavioral navigation. These programs are designed to support individuals in accessing mental health services, including therapy, and navigating the complexities of their treatment journey.

Case Management Programs

Their case management programs are tailored to meet the specific needs of individuals with high-cost behavioral conditions, providing care and case management services. Through these programs, Evernorth Insurance aims to ensure that individuals receive the appropriate care for their mental health conditions, including therapy as a component of their treatment plan.

Employer Access Programs

Employer Access Programs (EAPs) offered by Evernorth Insurance can also provide access to therapy services. These programs are typically designed to offer short-term counseling services to employees and their immediate family members. While EAPs may be more suitable for one-off services, EAP counselors can assist individuals in finding more long-term options if needed.

Concierge Behavioral Navigation Services

Evernorth Insurance also offers concierge behavioral navigation services to help individuals find the most appropriate providers and resources for their mental health needs. These services can assist individuals in locating therapists and coordinating their therapy sessions.

inMynd

Evernorth Insurance also offers inMynd, a Cognitive Behavioral Therapy (CBT) and Medication Management program. inMynd combines evidence-based CBT techniques with medication management to provide comprehensive support for mental health conditions. This program aims to empower individuals to manage their mental health effectively.

What Types of Coverage Does Evernorth Offer?

Evernorth covers a wide range of mental health conditions, including but not limited to depression, substance use disorders, anxiety disorders, bipolar disorder, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), and eating disorders. The coverage varies depending on the specific plan and level of care needed.

What Types of Therapy Are Covered by Evernorth?

Evernorth Insurance covers various evidence-based therapy modalities, including cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), psychodynamic therapy, interpersonal therapy, and family therapy.

When it comes to coverage for mental health conditions, Evernorth Insurance recognizes that the specifics may vary depending on the individual’s health plan and the level of care needed. In some cases, the coverage may include outpatient therapy sessions with licensed mental health providers, allowing individuals to engage in regular counseling sessions to address their mental health concerns. This can be particularly beneficial for individuals seeking support for depression, anxiety, or other common mental health conditions.

For individuals requiring a higher level of care, Evernorth Insurance may provide coverage for more intensive treatment options. This can include inpatient or residential treatment programs, which are designed to provide focused and intensive care for individuals experiencing severe mental health conditions or crisis situations.

Evernorth Insurance also recognizes the importance of medication in mental health treatment and coverage. As part of their mental health coverage, they may provide coverage for prescription medications used to manage mental health conditions. This can involve coverage for medications such as antidepressants, mood stabilizers, anti-anxiety medications, or other medications prescribed by mental health professionals.

It is important to note that specific coverage details for mental health conditions may vary depending on the individual’s health plan and any applicable limitations or exclusions. Always carefully review your insurance plan documents or consult with an Evernorth Insurance representative to better understand the scope of coverage for your specific situation.

What Types of Therapy Are Not Covered by Evernorth?

While Evernorth Insurance provides coverage for a wide range of therapy modalities, there may be some therapies or interventions that are not covered. Alternative therapies, such as art therapy or equine-assisted therapy, are not considered mainstream approaches to mental health treatment and may not be covered.

Evernorth also does not cover any therapy provided by therapists who do not have professional qualifications or licenses in your state. This includes life coaches without additional credentials, as well as alternative therapies like reiki healing or other energy-based practices that have not been scientifically validated.

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What if I Want Online Therapy?

Evernorth Insurance recognizes the growing popularity and accessibility of online therapy. Many Evernorth plans cover telehealth services, including online therapy, allowing members to receive mental health care remotely. It is important to verify the coverage for telehealth services under your specific Evernorth plan.

What if I Want Couples Therapy?

Couples therapy, also known as marital or relationship therapy, may be covered by Evernorth Insurance depending on the plan and level of care required. Evernorth’s EAPs offer access to couple’s therapy, but only for a limited number of sessions. EAP counselors can assist individuals in finding more long-term options for couples therapy, if needed.

If you do not have access to an EAP, however, you will not be able to receive coverage for couple’s therapy. Insurance providers don’t commonly offer coverage for couples therapy due to several reasons. One key reason is that relationship issues, in and of themselves, are not considered a mental health diagnosis. Insurance coverage for therapy typically requires a diagnosable mental health condition, and couples therapy is often classified as a non-covered service because it primarily focuses on interpersonal dynamics rather than individual mental health diagnoses.

Do I Need to Talk to a Doctor First?

This depends on your Evernorth plan. If you have a PPO plan, you do not need a physician’s referral to see one of Evernorth’s in-network providers. If you have an HMO or OAP plan, you are required to see your family doctor before accessing therapy services.

How Do I Check if My Evernorth Insurance Plan Covers Therapy?

To determine the coverage for therapy under your Evernorth Insurance plan, you can access your Summary of Benefits document in your member portal. There you will find information on coverage details, including mental health benefits and therapy coverage under the section titled “If you need mental health, behavioral health, or substance abuse services.”

If your Evernorth Insurance plan is through your employer, they should have also provided you with a Summary of Benefits document. If you’re having trouble finding the information you’re looking for, you can contact Evernorth directly and a representative can assist you in understanding your coverage and answer any questions you may have.

How Much Will Therapy Cost with Evernorth?

The cost of therapy with your Evernorth Insurance plan will depend on several factors, including your specific plan, the level of coverage, and whether the therapist is in-network or out-of-network.

In-Network vs. Out-of-Network Providers

Choosing an in-network therapist, who has a contractual agreement with Evernorth Insurance, typically results in lower out-of-pocket costs for members. Out-of-network providers may be covered, but the cost-sharing is often higher, and reimbursement rates may vary.

How Does Payment Work?

Payment for therapy services through Evernorth Insurance typically involves a combination of deductible, co-insurance, and co-payments, depending on the specific plan. Deductibles are the amount you need to pay before the insurance coverage begins. Co-insurance refers to the percentage of the cost you are responsible for after meeting the deductible. Co-payments are fixed amounts you pay for each therapy session.

For example, you might pay around 10% for co-insurance if you use an in-network provider for therapy. That means that if your therapy session costs $100, you’ll be responsible for paying $10. If you use an out-of-network provider, you can expect to pay around 30% for co-insurance, which means you will pay $30 for a $100 therapy session.

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How Do I Find an In-Network Evernorth Therapist?

Evernorth Insurance provides various resources to help members find a therapist. The member portal includes a directory of in-network providers, making it easier to search for and choose a therapist who meets your specific needs. Evernorth representatives can also assist you in finding appropriate and available therapists in your area. 

Another great option is. to use the Grow Therapy marketplace. Choose your state and insurance provider, then filter the results to find a therapist who meets your needs. You can add additional filters as well to narrow your results down even more if needed.

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FAQs

  • Evernorth Insurance is associated with Cigna Corporation, one of the world's largest health services organizations. By being part of the Cigna network, Evernorth Insurance has access to a wide range of resources and expertise to deliver high-quality care and coverage.

  • Evernorth has its own specific offerings and coverage options, though it operates under the umbrella of Cigna Corporation.

  • Express Scripts is a business unit operating under the Evernorth brand. Express Scripts provides pharmacy benefits management (PBM) services, focusing on improving pharmacy costs and clinical outcomes.

  • Evernorth Insurance stands out from other insurance providers through its commitment to whole-person health, which encompasses both physical and mental well-being. With its dedication to providing comprehensive, accessible, and affordable health services, Evernorth Insurance offers a range of health plans and benefit solutions tailored to meet the diverse needs of its members.

  • Evernorth Insurance provides coverage for therapy services through its case management programs, Employer Access Programs (EAPs), and concierge behavioral navigation.

About the author
derek lee grow therapy Derek Lee, VP of Insurance Operations

Derek Lee is Grow Therapy's Vice President of Insurance Operations, overseeing payor relations and success, credentialing and enrollment, new payor launch, revenue cycle management and billing, and insurance operations data analytics.

This article is not meant to be a replacement for medical advice. We recommend speaking with a therapist for personalized information about your mental health. If you don’t currently have a therapist, we can connect you with one who can offer support and address any questions or concerns. If you or your child is experiencing a medical emergency, is considering harming themselves or others, or is otherwise in imminent danger, you should dial 9-1-1 and/or go to the nearest emergency room.

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