Orlando Harmon
The world of health insurance can be confusing, but it's important to understand what your insurance covers, especially when it comes to therapy and mental health services. In the US, most health insurance plans cover individual therapy and counseling, but the specifics depend on your particular plan. Some plans may have negotiated rates with in-network therapists, while others may require preauthorization for out-of-network reimbursements. It's always a good idea to check with your insurance company and understand your benefits before starting therapy to ensure you're aware of any potential out-of-pocket costs.
| Characteristics | Values |
|---|---|
| Affordability | The cost of therapy with insurance is roughly $21 in-network and $60 out-of-network in the U.S. |
| Insurance plans | Many insurance plans cover some amount of therapy. |
| Insurance coverage | Insurance coverage depends on the company and the plan. |
| In-network therapists | Therapists in your plan's network should be available online. |
| Out-of-network therapists | Out-of-network services may require a "superbill" for reimbursement. |
| Online therapy | Some online therapy companies accept insurance, while others do not. |
| Telehealth services | Some insurers cover telehealth services for in-network providers. |
| Billing codes | Billing codes are covered differently by insurance plans. |
| Preauthorization | Some insurers require preauthorization for out-of-network reimbursements. |
| State laws | State laws may ensure that individuals with health insurance receive necessary mental health care. |
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What You'll Learn
In-network therapists
To find an in-network therapist, you can start by checking your insurance provider's directory or website. This should provide you with a list of in-network therapists and information about your coverage and costs. You can also use platforms like Grow Therapy and Talkspace, which allow you to search for therapists by filtering your insurance company. These platforms can also help you understand your insurance benefits and estimate the cost of therapy. Additionally, you can contact your insurer through their online portal or by calling the number on the back of your health insurance card. They can confirm whether your policy covers mental health treatment and provide a directory of in-network therapists.
It is important to note that even if you find a therapist listed as in-network, it is always a good idea to call their office to confirm that they still accept your specific insurance plan. You may also want to take advantage of the free 15-minute consultations that many therapists offer to discuss pricing and payment options.
If you are having trouble finding an in-network therapist, it may be worth considering telehealth options. Telehealth therapy, conducted through phone or video conference, can provide a larger selection of potential providers as you can see anyone licensed in your state. Additionally, many large companies offer employee assistance programs (EAPs) that provide access to therapy and counseling services at low or no cost.
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Out-of-network therapists
Firstly, it can often be difficult to find a therapist who is accepting new patients, and an out-of-network provider might be available more quickly. Secondly, out-of-network therapists might be able to offer more individualized or niche care as they are not bound by as many insurance rules. Additionally, if there are no in-network therapists in your area, an online therapist could be a good option for you.
It is important to note that the reimbursement rates for therapists from insurance companies have generally not changed in decades, and many therapists do not accept health insurance because they say that these rates are too low. As a result, the amount of money an insurance company pays is often not enough to cover the therapist's expenses. This means that finding an in-network therapist who accepts your insurance can be challenging.
If you choose to see an out-of-network therapist, you will likely have to pay the full cost upfront and then wait to get reimbursed by your insurance company. The reimbursement process can vary, so it is important to ask your clinician about their process ahead of your first appointment. Some therapy offices will submit insurance claims on your behalf, while in other cases, you will be responsible for submitting the claim yourself. Your insurance company will then pay you back for their portion of the cost. It could take up to a few months to get reimbursed for out-of-network therapy, so it is important to understand your insurance company's policies for out-of-network reimbursement.
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$45.5
Online therapy
Whether your medical insurance covers online therapy depends on your insurance provider and your location. Some insurance policies cover online sessions, while others do not. Many insurance companies cover online therapy services, but some require video for therapy.
During the COVID-19 pandemic, most providers and insurers responded by increasing access to teletherapy for existing patients and new ones. They established new procedures or waivers to allow for the coverage of online therapy. Some of these policies and waivers are still in effect, depending on where you live and your insurance provider.
Medicare telehealth visits include office visits, psychotherapy, consultation, and other medical or health services offered by a provider located elsewhere using two-way real-time audio and video technology. Most Medicare and Medicaid plans cover telehealth, but coverage varies by state and plan. According to the Center for Connected Health Policy, Medicaid covers online therapy in each state except for Iowa. It is always a good idea to call and confirm that online therapy is covered by your specific plan before connecting with an online therapist.
Some online therapy providers that accept insurance include Talkspace, Grow Therapy, and MDLIVE. Talkspace works directly with providers like Cigna, Optum, and Aetna to make therapy more affordable. It also offers several communication platforms, therapy options, and flexible subscription plans. It can also prescribe medication and accepts most major insurances. You can check its partner list to see if you're covered. Brightside is another online therapy provider that accepts more than 20 insurance plans, including major insurers like Aetna, Anthem, Blue Shield, and UnitedHealthcare.
If you are unable to afford your health insurance deductible, there are other options for affordable online therapy. Alternatives include a therapy website or app, a community resource, or a therapist with sliding scale payment options.
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Types of therapy covered
The types of therapy covered by insurance vary depending on the insurance company and the specific plan. It's important to carefully review your insurance plan to understand what types of therapy are covered. Here are some common types of therapy that may be covered:
- Individual Therapy: Many health insurance plans cover individual therapy and counseling. This typically involves one-on-one sessions with a therapist to address mental health concerns.
- Group Therapy: Some insurance plans may cover group therapy sessions, where individuals with similar struggles meet together with a therapist.
- In-Network Therapy: Therapy provided by a therapist who is part of your insurance company's network is more likely to be covered. Each insurance company has a list of in-network therapists that you can choose from.
- Outpatient Therapy: Outpatient therapy services are often covered by health insurance plans. This includes therapy sessions that you attend as an outpatient rather than being hospitalized.
- Mental Health Services: Insurance plans are increasingly covering mental health services, including therapy for conditions like anxiety disorders.
- Telehealth Therapy: With the rise of remote services, some insurance companies now cover telehealth therapy, where sessions are conducted virtually through video or phone calls.
- Substance Use Disorder Therapy: In certain regions, such as California, health insurance plans are required to cover substance use disorder services, which may include therapy for substance abuse.
- Prescription Drugs: If your health plan includes prescription drug coverage, it may also cover medications prescribed by a therapist or psychiatrist for mental health conditions.
It's important to note that some insurance plans may have specific requirements or limitations on the number of therapy sessions covered or the length of each session. Additionally, alternative therapies, such as hypnotherapy or niche methodologies, may not be covered by insurance. Always verify coverage with your insurance provider and understand the specifics of your plan.
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Additional costs
Before insurance will pay for therapy, you may need to meet your deductible, which applies to all medical services, not just therapy. This means that you will need to pay the full fee for each session until you have paid enough to meet the deductible. Some insurance companies may also require a mental health diagnosis before they will pay claims, as they only cover medically necessary services. It is important to review your insurance policy, specifically the Explanation of Benefits (EOB), to understand what is covered and what your deductible is. Tools like Alma's Cost Estimator can help you calculate the cost of your copay and how close you are to meeting your deductible.
If you are considering online therapy, it is important to check if it is included in your health insurance plan, as some insurance companies may re-evaluate whether the services are medically necessary if they notice excessive online sessions. Additionally, some plans may limit the number of sessions you can attend each year, and using an out-of-network therapist may increase your out-of-pocket costs.
There are alternative options to help with the cost of therapy. Some therapists accept patients on a sliding scale based on their ability to pay, and some even offer pro bono services. Under the Affordable Care Act, some mental health care facilities offer outpatient services on a sliding scale fee for those with lower incomes. Graduate students training in psychology under the American Psychological Association (APA) guidelines may also provide low-cost services. A health savings account (HSA) or flexible spending account (FSA) can also be used to save money tax-free for medical expenses.
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Frequently asked questions
It depends on your particular plan. Many insurance plans cover some amount of therapy, but not all. Before starting therapy, it is recommended to call your insurance company to ask about coverage for therapy.
Your health insurance plan’s website should contain information about your coverage and the costs you can expect. You can also refer to your insurance card, which lists the type of plan you have.
You can call the customer service phone number on your insurance card. If you are insured through your employer, you can also contact your human resources (HR) department.
If you need therapy but can’t afford it, you can request recommendations from a trusted professional, such as a doctor or clergy member. You can also use a tool like Covered California’s Shop and Compare to find out which health plan options are available to you.
