Troubleshooting insurance problems

Navigating health insurance for mental health services can feel overwhelming. Many people face confusing policies, jargon, and claims denials that make accessing and paying for care more stressful. With the right tools and guidance, you can navigate the process without being buried in paperwork or overwhelmed by financial stress. This guide simplifies common insurance hurdles and provides practical solutions, empowering you to focus on your mental well-being instead of paperwork.

How can I tell if my health insurance covers therapy?

The first step to accessing mental health care is determining if your health insurance covers therapy. Understanding your coverage is essential, and there are several ways to check your benefits and ensure you’re aware of the support available to you.

Call your insurance provider

The quickest way to get information about your coverage is to call the customer service number on your insurance card. When you call, be prepared with your insurance ID and take detailed notes during the conversation, including the representative’s name and any important details they provide.

Here are some key questions to ask:

• Does my plan cover mental health services, including therapy, psychiatry, and counseling?
• Do I need a referral or preauthorization to see a therapist?
• Are there any restrictions on the types of therapy covered?
• How many therapy sessions are covered per year?
• What are my copays, deductibles, and out-of-pocket costs?
• What is the difference in cost between out-of-network and in-network providers?
• Are teletherapy/online therapy services covered?
• What is the process for getting reimbursed if I see an out-of-network therapist?

Check your insurance plan documents

Your insurance provider’s website or member portal may have a Summary of Benefits and Coverage (SBC) document that outlines what mental health services are included in your plan. This document will help you understand what is and isn’t covered, including specific exclusions, limitations, and cost-sharing details. Coverage may vary depending on whether you have private insurance, employer-sponsored coverage, Medicaid, or Medicare.

Therapies that are typically covered by insurance

Most health insurance plans cover a range of evidence-based mental health treatments, particularly when deemed medically necessary. These often include:

• Psychotherapy – Individual, group, and family therapy sessions provided by licensed mental health professionals like psychologists, LCSWs, and LPCs.
• Cognitive behavioral therapy (CBT) – A structured, evidence-based treatment for anxiety, depression, and other mental health conditions.
• Dialectical behavior therapy (DBT) – Often covered for borderline personality disorder (BPD) and emotion regulation issues.
• Medication management – Psychiatric evaluations and ongoing medication monitoring by psychiatrists or nurse practitioners.
• Teletherapy (virtual or online therapy) – Many insurance plans now cover online therapy sessions, though coverage may vary by state and provider.
• Treatment for substance use disorder (SUD) – Includes inpatient/outpatient programs, detox services, and therapy for addiction recovery from alcohol and substance abuse.
• Trauma therapy (e.g., EMDR, exposure therapy) – Some insurers cover trauma-focused treatments for post-traumatic stress disorder (PTSD) and related conditions.
• Behavioral therapy for autism spectrum disorder (ASD) – Applied behavioral analysis (ABA) therapy and other behavioral interventions for ASD may be covered under specific health plans.
• Inpatient or partial hospitalization – Treatment in a hospital or rehabilitative setting.

Therapies that may not be covered or have limited coverage

Insurance plans may have limited coverage for certain therapies. Family or couples therapy may not be covered unless it directly relates to a diagnosed mental health condition. Treatments classified as experimental or alternative, such as neurofeedback or hypnotherapy, may require additional documentation for reimbursement.

• Holistic therapies – Treatments like reiki or aromatherapy are usually not covered.
• Career counseling – Therapy focused on career issues is not reimbursed unless linked to a diagnosed mental health condition.
• Experimental therapies – New or unconventional treatments like hypnotherapy, neurofeedback, or nature-based adventure-based interventions are often not covered.
• Family and couples therapy – Limited or no coverage for family/couples therapy is common, unless it is essential to the treatment of a diagnosed mental health condition.

Use a service like Grow Therapy

If you’re not sure where to begin, Grow Therapy can help. They’ll verify whether your insurance is accepted and provide an estimate of your therapy costs. Grow Therapy simplifies the journey to care by connecting you with licensed mental health professionals who work with your insurance, making it easier to find support that fits your coverage.

How do I get pre-authorization for therapy?

Most insurance plans, including Medicaid and Medicare, do not require preauthorization before covering therapy. If your plan does require it, the process is meant to determine whether treatment is medically necessary and cost-effective. To understand if pre-authorization is needed, and how to get it, it’s recommended that you call your insurance company.

The process can vary depending on the insurance plan. But typically, it begins with a consultation with a mental health provider who assesses your condition and recommends treatment. If preauthorization is needed, your provider, such as a primary care physician, psychiatrist, or therapist, submits a request to your insurance company with details about your diagnosis, symptoms, and treatment plan.

The insurance company reviews the request, sometimes consulting medical professionals to ensure the therapy meets their guidelines for behavioral health care. Approval can take anywhere from a few days to several weeks. If approved, therapy can begin.

What if my bill is incorrect or confusing?

Billing issues are common in mental health care, often causing unexpected charges, maxed-out benefits, or denied claims. If you suspect an error, start by reviewing your Explanation of Benefits (EOB). This document from your insurer outlines what was billed, covered, and owed, helping you spot discrepancies like incorrect service codes, duplicate charges, or in-network services billed as out-of-network.

If you spot mistakes, contact your insurer or provider for clarification. Issues often stem from errors like incorrect coding or missed preauthorization, and your provider may need to resubmit the claim. Denied claims can be appealed. Be sure to check your plan details, including deductibles, session limits, or network restrictions. It can clarify partial coverage, especially with Medicare and Medicaid, which follow strict rules.

What if the therapist I want to see doesn’t take my insurance plan?

If your preferred therapist doesn’t take your insurance, there are still ways to get care. Check to see if your insurance offers out-of-network benefits, which may allow you to get reimbursed for part of your therapy costs. Reimbursement rates and deductibles vary, so confirm your coverage with your insurer.

If you don’t have out-of-network coverage, you can consider paying out-of-pocket. Many therapists offer sliding-scale fees based on income. You can also use pre-tax dollars from Health Savings Accounts (HSA) or Flexible Spending Accounts (FSA) to cover costs.

For more affordable options, use your insurance company’s directory or platforms like Grow Therapy to find in-network mental health providers. Grow Therapy’s search tool filters therapists by insurance, saving time and effort.

What if my therapist stops taking insurance?

If your therapist stops taking your insurance, your options are similar to that of seeing a therapist who doesn’t take insurance. You can look into out-of-network coverage with your insurance, to see if you’re eligible for partial reimbursement if you keep seeing your same therapist. You can also pay out-of-pocket, and see if your therapist is open to sliding-scale fees for lower rates. You can also use HSA or FSA funds to help with costs.

Another option is finding a new in-network provider. Insurance companies often have directories, and platforms like Grow Therapy can connect you with covered therapists. You can also ask your current therapist for a referral to an in-network colleague. These steps can help you stay on track with your mental health care.

What if my claim is denied?

Denied insurance claims are a common issue in mental health care. Review your insurer’s EOB to understand the reason for denial, such as billing errors, missing preauthorization, or claims that the treatment wasn’t medically necessary. If unclear, contact your insurer for details.

If it’s a billing error, ask your provider to correct and resubmit the claim. For missing preauthorization, your provider may be able to submit documents retroactively. If the denial is due to medical necessity, file an appeal with your insurer. Work with your therapist to gather supporting documents, like progress notes and treatment plans, to show why your care is needed. Some insurers also offer peer-to-peer reviews, where your provider can discuss your case directly with their team.

Appeals have strict deadlines, so act quickly. If you’re unsure what to do, mental health advocacy groups can guide you through the appeal process and help defend your right to medical care.

How do I get reimbursed for out-of-network coverage?

If you see a therapist outside your insurance network, you may still be eligible for partial reimbursement. Many insurance plans offer out-of-network health benefits, but the reimbursement process requires careful documentation.

First, confirm with your insurance company whether your plan includes out-of-network coverage and ask about any deductible requirements. Some plans require you to meet a separate deductible before they begin reimbursing you for out-of-network services.

To submit a claim for reimbursement, you’ll need a superbill, which is a detailed invoice from your therapist outlining the services provided, dates of sessions, and associated costs. Your insurer may also require a completed claim form. Ensure that all necessary paperwork is submitted promptly, as insurance companies often impose strict deadlines.

Reimbursement rates for out-of-network health care providers vary. Some insurers cover a percentage of the cost, while others use a set usual and customary rate that may differ from your therapist’s charges. If your reimbursement is lower than expected, you can appeal or negotiate with your insurer. For help with out-of-network reimbursement, ask your therapist or contact your insurer’s customer service for instructions.