Using insurance for therapy and mental health
The cost of therapy is often a major barrier to treatment. But, many people don’t realize that their health insurance covers mental health services, making the path to improved mental wellness more affordable. Every health insurance company and plan is different, but generally speaking, your insurance likely does cover mental health, reducing your out-of-pocket costs for therapy services. Understanding your insurance benefits is key. Keep reading to learn all about using insurance for therapy and mental health.
Does insurance cover therapy?
In most cases, insurance covers therapy services through your health insurance plan’s mental health benefits. The exact coverage will vary based on your insurance company. Sometimes, you may just pay a low copay (also known copayment), which is a fixed fee per visit. Or, you might have to pay a coinsurance amount: a percentage of the cost of services. Some health plans may have a deductible you must meet — meaning an amount of money you have to spend before it starts paying for services.
If you use insurance for therapy, your provider must diagnose you with a mental health condition, which becomes part of your medical record. Some people prefer to pay out-of-pocket for therapy to maintain privacy and avoid potential insurance restrictions
In the US, certain mental health coverage is mandated by law. The Mental Health Parity and Addiction Equity Act of 2008 ensures that if an insurance plan covers mental health care, it must do so at the same level as medical or surgical care. However, not all plans are required to offer mental health benefits, and certain employer-funded plans may have exemptions. Additionally, the Affordable Care Act (ACA), enacted in 2010, deemed mental health and substance abuse services “essential health benefits.” This means that all government marketplace plans cover behavioral health and mental health services. Medicaid and Medicare must also cover mental health.
Does insurance cover online therapy?
Most insurance companies cover telehealth appointments, including online therapy. The COVID-19 pandemic led to the rise of telehealth and insurance coverage of virtual services. The benefits of online therapy are numerous, including increased accessibility to more mental health professionals and no commute to a provider’s office. To make sure that your insurance plan covers services through an online therapy platform, contact your insurer directly.
Does insurance cover couples therapy?
Couples therapy is often not covered by insurance unless at least one partner has a mental health diagnosis and the therapy is aimed at treating that condition. Some insurance plans may offer partial coverage, so it’s best to check with your provider about specific benefits.
When it comes to therapy, a diagnosis is typically required to determine medical necessity, which then prompts the insurance company to cover the treatment. Since couples therapy tends to focus on relationship problems, not mental health conditions, it’s usually not covered.
However, if there is an underlying mental health condition that is contributing to the relationship issues, you might be able to get some coverage. Still, it depends on your insurance. You can read more about couple’s therapy insurance coverage here.
What are the pros and cons of using insurance for therapy?
There are various pros and cons of using insurance for therapy, including:
Pros:
- More affordable mental health care
- Potential low-cost — or even no-cost — treatment, depending on your plan
- Therapy costs might apply toward your overall deductible
Cons:
- It limits your selection of therapists to ones who are in-network (if you don’t have out-of-network benefits)
- Some highly experienced therapists or therapists who specialize in less common treatment modalities do not take insurance
- Copays, coinsurance, and deductibles may be high for some plans
- Mental health professionals who accept insurance might have longer waiting times/waiting lists to start treatment
How can I check whether my insurance covers therapy?
There are a few ways to check whether your insurance covers mental health treatment.
Check your plan’s website or documentation
If you have a hard copy of your plan documents, check those. If not, check your insurance carrier’s website for the Summary of Benefits and Coverage (SBC). The SBC will clearly outline what’s covered.
Call your health insurance company
Check your insurance card to find the Member Services phone number. Once connected, ask the following questions.
- Does my plan cover therapy?
- How much is my copay or coinsurance for therapy?
- Do I have to reach a deductible?
- Do I need a referral for therapy?
- Is there a limit on the number of sessions insurance will cover?
- Does my plan offer out-of-network benefits? If so, what are they?
Use a provider like Grow Therapy
Grow Therapy can help you find a skilled therapist who’s covered by your health insurance. Once you find a provider you’re interested in, we can verify insurance for you. We will ask for your plan information and then check if your insurance is accepted and give you a cost estimate. Therapy costs vary significantly, but the average cost of therapy for people who use Grow Therapy is $0-$50 per session. Your individual cost will vary depending on your plan’s deductible, copay, and provider network.
What’s the difference between in-network and out-of-network?
There are two different types of providers: in-network and out-of-network. An in-network provider has a contract with your insurance company. This means your insurance will cover the services of an in-network provider, and you will just have to pay any applicable copay or coinsurance rate.
Out-of-network providers are not contracted with your insurance company. They might not accept any insurance plans at all, or they just may not accept your specific plan. You can still visit an out-of-network provider, but it will be more expensive. You might have to pay full price out-of-pocket to see them. In some cases, your insurance may offer out-of-network benefits to help you pay for out-of-network providers. Check with your insurance to ask if they offer out-of-network benefits and if so, any guidelines.
Do I need a referral to see a therapist with my insurance?
Whether or not you need a referral depends on your insurance. Many insurance plans, especially PPO (preferred provider organization) plans, do not require a referral to see a therapist. However, other insurance plans might require you to get a referral from your primary care physician for insurance to cover your therapy. Check your Summary of Benefits and Coverage or call Member Services to see if your plan requires a referral.
Will insurance reimburse me for therapy?
If you have out-of-network benefits, your insurance may reimburse you for some of your therapy costs if you see an out-of-network provider. Always check with your insurance beforehand to clarify guidelines around out-of-network benefits and reimbursements.
Therapists can provide you with a “superbill” to submit to your insurance. Some therapists do this automatically, but you may have to ask for one. The superbill will include your provider’s details, dates of service, service codes, diagnostic codes, and fees. Your insurance will review this superbill and reimburse you accordingly.
Keep in mind that you may not get reimbursed the full amount, and it’s possible that your insurance might deny a claim altogether. Often, out-of-network reimbursements are for an “allowable amount,” which is what your insurance carrier deems an appropriate fee for the service — and this may be less than what your therapist charges. Reimbursement rates vary by insurance provider and plan.
Does my therapist file insurance for me?
Generally, your in-network therapist should bill insurance for you. When you first start seeing them, they will ask for a photo of your insurance ID card so they have all the necessary plan information. Your provider will file the claim with insurance, and you will pay the copay or coinsurance for your therapy sessions directly to your therapist.