Insurance

Your Guide to Optum Therapy Coverage

Taking care of your mental well-being is just as crucial as tending to your physical health. Yet, the cost of therapy can be a stumbling block for many who wish to seek professional help. This is where understanding your insurance benefits is vital. This article is designed to help you navigate your Optum therapy coverage. […]

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

Updated on Feb 27, 2024

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Taking care of your mental well-being is just as crucial as tending to your physical health. Yet, the cost of therapy can be a stumbling block for many who wish to seek professional help. This is where understanding your insurance benefits is vital.

This article is designed to help you navigate your Optum therapy coverage. We’ll explore what types of mental health services are covered, the conditions under which you can use these services, and how to make sure you’re getting the most out of your insurance plan.

So, let’s dive into what you need to know about Optum therapy coverage and get you on the path to mental wellness.

Does Optum Insurance Cover Mental Health Services?

Yes, Optum Insurance does cover mental health services. Optum places a strong emphasis on behavioral and mental health, making it easier for you to take that critical step toward well-being. They offer a comprehensive range of mental health services, including but not limited to outpatient treatment and inpatient care. This is great news for anyone who has been hesitant to seek help due to financial concerns or uncertainty about insurance coverage.

Optum’s mental health coverage not only aligns with the Affordable Care Act’s mandates for essential health benefits but also strives to provide a holistic approach to care. This means you get a wide array of options, from preventive to acute care, and can choose what best suits your individual needs. At Grow Therapy, we can help connect you with therapists who are in-network with Optum, ensuring that you can access affordable and effective treatment.

The specifics will depend on your particular plan, so it’s important to familiarize yourself with its details.

What Types of Therapy Does Optum Cover?

Optum has an extensive range of treatments designed to meet your unique needs. Among the therapeutic approaches covered are:

This range of therapeutic modalities means that you can choose an approach that resonates with you, whether you’re dealing with emotional, psychological, or even physiological challenges.

Alongside these therapies, Optum is geared to address various conditions that you or a loved one might be experiencing. These conditions include but are not limited to depression, anxiety and stress, alcohol abuse, infertility concerns, grief and loss, eating disorders, and learning disabilities. Each of these conditions requires specialized care, and Optum’s broad coverage ensures that you don’t have to compromise on your healing process.

Moreover, Optum has a particular commitment to providing support for members and their families who are diagnosed with Autism Spectrum Disorder. They offer personalized coverage to help these individuals build social skills, reduce problem behaviors, and improve their quality of life.

If seeing a mental health provider in person is out of the question for you, you’re still covered by Optum. All of their plans include virtual visits, so you can meet with your Grow Therapy counselor online from the comfort of your own home.

What Optum Doesn’t Cover

While Optum aims to cater to a variety of individual needs, it’s important to be aware of what is not included under their healthcare plans. Optum emphasizes evidence-based treatments for mental health conditions, which means there are certain services and approaches that don’t make the cut.

For instance, life coaching and career coaching are not covered by Optum. Although these services can be beneficial for personal development and goal-setting, they’re not designed to address mental health conditions and therefore don’t align with Optum’s focus on evidence-based care. The same goes for more holistic approaches to treatment. If you’re considering therapies like aromatherapy, massage therapy, acupuncture, or nutritional therapy for mental well-being, keep in mind that these are not covered by Optum.

This extends to newer and experimental treatments like ketamine and psychedelic treatments. Even if these are aimed at treating a mental health condition, Optum doesn’t cover them. This is because the company is committed to data-driven behavioral health practices. They place a high value on scientific rigor and evidence-based treatments. In other words, if a treatment method isn’t backed by substantial scientific research demonstrating its effectiveness in treating mental health conditions, it’s unlikely to be covered by Optum.

Even though Optum has a broad spectrum of mental health services they support, being aware of what they don’t cover can save you time and resources as you make your healthcare decisions.

How to Check Your Optum Therapy Coverage

Verifying your insurance coverage is a crucial step before starting therapy. It not only prepares you for any financial commitments but also provides a clear picture of which treatments are accessible under your plan. Fortunately, Optum makes this process straightforward.

To confirm what your Optum insurance covers in terms of mental health services, you can follow these simple steps:

Taking these steps gives you access to details about your coverage, whether it’s inpatient services, outpatient services, or special forms of therapy like CBT. This is also where you’d find out about any necessary prerequisites for coverage like referrals or prior authorization. It provides a foundation of knowledge that can guide you as you explore different therapeutic options, so you can make an informed decision about your mental health treatment plan.

How Much Does Therapy Cost with Optum?

The cost of therapy when using any type of insurance is influenced by a multitude of factors. To start, the pricing for therapy sessions can differ greatly depending on the provider you choose. Various elements such as the geographic location of the practice, the kinds of services offered, and the level of expertise and training of the mental health professional contribute to these costs. For instance, a seasoned psychologist may have a different fee structure compared to a licensed clinical social worker (LCSW), due to their distinct qualifications and scopes of practice.

Furthermore, the extent of your insurance coverage under Optum can significantly affect the overall expense. Factors like the specifics of your insurance plan, your geographical location, and whether the therapist is an in-network or out-of-network provider all come into play. Optum offers different plans with diverse coverage options that can either minimize or expand your out-of-pocket costs for therapy. By understanding these variables, you can gain a clearer picture of what financial commitment may be required of you as you proceed with your therapeutic journey.

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In-Network vs. Out-of-Network

The distinction between in-network and out-of-network providers can greatly impact the costs and accessibility of mental health services when using Optum insurance. In-network providers are those professionals who have a contractual relationship with Optum, often resulting in more favorable financial terms for you. This could mean lower copays, deductibles, or out-of-pocket costs, making the overall experience more affordable. Additionally, working with in-network providers simplifies the billing process, as they directly coordinate with Optum for claims and reimbursements. Grow Therapy can help match you with an in-network mental health professional if you are covered by Optum.

On the other hand, out-of-network providers haven’t entered into an agreement with Optum, and thus their services usually come with higher out-of-pocket costs. It’s not just about paying more; you may also have to go through the additional steps of paying the full fee upfront and then seeking reimbursement from Optum yourself. While going out-of-network does provide you with a wider range of professionals to choose from, sometimes it can be less friendly on your wallet.

Optum places a high value on evidence-based, effective mental health care and has a broad network of qualified in-network providers. Always check your specific plan details to understand the financial implications and authorization requirements when weighing your options.

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Deductibles

A deductible is a set amount you’re required to pay out of pocket within a policy year before Optum begins covering your healthcare expenses. The amount of your deductible can vary based on several factors, including the specific Optum plan you’re enrolled in and whether you’re receiving treatment from an in-network or out-of-network provider. If you have dependents on your plan, that can also affect the cost structure.

Optum offers a range of plan options to suit different needs and budgets. The specific deductible amounts will vary depending on your plan, and lower monthly premiums often have higher deductibles, meaning you’ll pay more out of pocket before insurance kicks in. Conversely, plans with higher monthly premiums typically offer lower deductibles and more extensive coverage.

For the most accurate and personalized information, check your plan online or give Optum a call.

Copays

Copays are set fees that you’re required to pay when you receive services from a therapy provider. These are due at the time of billing and vary depending on your specific Optum insurance plan. While some Optum plans might require copays in the ballpark of $20-30 per therapy session, others might not require them at all. It’s important to note that these copay fees don’t contribute toward meeting your deductible, but they do count toward your plan’s out-of-pocket maximum.

An out-of-pocket maximum is the ceiling on how much you would need to pay in a given policy year for services covered by your insurance. Once you reach this limit, Optum would cover the remainder of your healthcare costs for the year. Like deductibles and premiums, copays and out-of-pocket maximums are influenced by the particulars of your plan. Plans that come with lower monthly premiums generally require higher copays and have higher out-of-pocket maximums. Therefore, understanding your plan’s structure can help you anticipate your potential costs.

Finding a Therapist

When it comes to finding a therapist who accepts Optum insurance, you have several options to consider. One way is to call the customer service number located on your Optum ID card, where a representative can assist you in locating a suitable provider. Another option is to use Optum’s online search tool, which enables you to filter therapists based on their areas of specialization, geographical location, and other criteria. Additionally, you can turn to Grow Therapy, which partners with Optum, to find an in-network therapist in your area. Through Grow Therapy, you can further narrow your search by specialties or other preferences, ensuring you find a provider who’s the best fit for your needs.

FAQs

  • Optum is a part of the UnitedHealth Group, though their offerings might differ slightly from UnitedHealth.

  • Oscar partners with Optum Health to provide behavioral and mental health coverage for its members.

  • Using the card streamlines the payment process for qualified medical costs, eliminating the need to fill out paper claim forms. It's accepted at pharmacies, can be used for payments at your doctor's office, or you can simply jot down the card number on your bill from the healthcare provider.

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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