Jane Dotson
Therapy can be expensive, with the average cost of a session being over $180. Many people cannot afford this, and health insurance can help cover the costs. However, finding a therapist who accepts insurance can be challenging. Some therapists are out of network, meaning patients have to pay upfront and get reimbursed later. Others are in-network, billing the insurer directly and only charging the patient a copay or coinsurance fee. Federal law requires insurers to cover mental health treatment at similar levels to physical health, but many therapists are leaving insurance networks due to low reimbursement rates. As a result, fewer than 40% of therapists are in-network with even a single health plan, and patients may struggle to find a therapist who takes their insurance.
| Characteristics | Values |
|---|---|
| Affordability | Therapy sessions can be expensive, often between $100 and $200 per session. Insurance can help reduce the cost. |
| Therapist Availability | Many therapists don't accept insurance, and those who do may not be accepting new patients. |
| Insurance Coverage | Coverage varies depending on the insurance company and plan. Some plans have restrictions or require partial payment. |
| In-Network vs Out-of-Network | In-network therapists bill the insurer directly, with patients paying a copay or coinsurance fee. Out-of-network therapists may be covered partially, requiring upfront payment and subsequent reimbursement. |
| Medical Diagnosis | Insurance companies typically cover treatment for diagnosed mental health conditions. |
| Plan Types | Plan types (HMO, PPO, EPO) affect access to mental health services and have different rules for coverage. |
| Employer-Provided Insurance | Employers with over 50 employees are required to offer health insurance with mental health services. |
| Alternative Options | Alternatives for those without insurance include sliding scale therapy fees, community health centers, and online therapy platforms. |
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What You'll Learn
In-network therapists
When it comes to medical insurance, a therapist is typically classified as an in-network provider or an out-of-network provider. In-network therapists have agreed to provide services to insurance plan members at pre-negotiated rates, and they usually bill the insurer directly. This means that if you visit an in-network therapist, you will only be responsible for your copay or coinsurance fee after meeting your deductible.
Finding an in-network therapist can be challenging, as fewer than 40% of therapists are in-network with even a single health plan. However, there are several ways to locate one. Firstly, you can log into your insurance provider's website or app and search for a directory of in-network therapists, filtering by specialty or location. You can also call the number on your health insurance card to confirm whether your policy covers mental health treatment and to get more information about in-network therapists. If you have insurance through your employer, you can also reach out to your human resources department to clarify your mental health benefits.
It's important to note that insurance companies typically only cover medically necessary services that require a mental health diagnosis, such as depression or anxiety. They may also cap the number of therapeutic visits they'll pay for annually. Therefore, it's essential to understand your insurance plan's specific coverage and requirements before seeking therapy services.
Online therapy platforms, such as Talkspace, can also be a good option, as they are often in-network with many major insurance plans and may even offer a $0 copay. Additionally, telehealth services can open up more options for finding in-network therapists, as you can see any therapist licensed in your state.
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Out-of-network therapists
When looking for a therapist, you have the option to choose between in-network and out-of-network providers. In-network therapists have negotiated a contracted rate with your health insurance company and are typically more affordable than out-of-network therapists. Out-of-network therapists are those who have not negotiated a contracted rate with your health insurance company. This means that they are often more expensive than in-network therapists, as the insurer may only be willing to pay a certain amount towards therapy with that provider.
If you choose an out-of-network therapist, you will likely have to pay the full price of the session upfront and then claim reimbursement from your insurer. The reimbursement process can vary from therapist to therapist, so it is important to ask about this before your first appointment. Some therapy offices will submit insurance claims on your behalf, while others will require you to submit a claim yourself. In the latter case, the therapist will give you a superbill, which is a detailed receipt that you can submit to your insurance provider. Your insurer will then process the claim and reimburse you for their portion of the cost.
It is important to note that not all therapists accept insurance, and among those who do, many are not accepting new patients. This can make it challenging to find a therapist who takes your insurance. However, seeing an out-of-network therapist can have some benefits. For example, out-of-network therapists may be able to offer more individualized or niche care, and they may have shorter wait times for appointments. Additionally, if you have a PPO or POS health insurance plan, you may receive partial reimbursement for out-of-network services, making it more cost-effective to see an out-of-network therapist.
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Insurance coverage for therapy
Therapy can be expensive, and insurance coverage can help make it more accessible. Many insurance plans cover therapy to some extent, but the level of coverage varies depending on the specific plan. It is important to understand the details of your insurance plan and what therapy services are covered.
Understanding Your Insurance Plan
To determine if your insurance plan covers therapy, you can start by reviewing your plan details. Log into your insurer's online portal or refer to your policy documents to check the coverage and any associated costs. Your insurer's website should provide information about your specific plan and coverage. It is important to note that different insurers offer various plans, so ensure you are reviewing the correct plan.
In-Network vs. Out-of-Network Therapists
Therapists who are part of your insurance plan's network are known as "in-network" providers. When using an in-network therapist, they will bill your insurer directly, and you will typically only be responsible for your copay or coinsurance fee after meeting your deductible. However, finding an in-network therapist who is accepting new patients can be challenging, as not all therapists accept insurance.
If you choose an "out-of-network" therapist, meaning they are not part of your insurance plan's network, the insurer may cover a smaller portion of the fee, or you may need to pay the full cost upfront and seek reimbursement. It is important to review your policy to understand how out-of-network therapy services are handled.
Medical Diagnosis and Billing Codes
Insurers typically cover therapy only if it is deemed medically necessary and tied to a specific medical diagnosis, such as depression or anxiety. They may also require certain billing codes for therapy sessions to be covered. Common billing codes include 90791 for the initial intake interview and 90832 for 30-minute therapy sessions. Confirm with your therapist and insurance company which billing codes they use and cover.
Alternative Options
If you encounter challenges finding an in-network therapist or have difficulty affording the costs, there are alternative options to consider. Some therapists offer sliding scale fees based on your income, making therapy more accessible. Additionally, telehealth services have expanded the pool of potential therapists, as you can access providers licensed in your state remotely.
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Types of therapy covered
The types of therapy covered by insurance vary depending on the type of health insurance and the state. Federal law requires health insurance provided by large employers or via the health care marketplace to cover mental health treatment at levels similar to those at which it covers physical health. However, it is important to note that therapy is typically only covered if it is considered medically necessary and requires a mental health diagnosis.
Some types of therapy that may be covered by insurance include:
- Talk therapies, such as psychotherapy and cognitive-behavioural therapy (CBT).
- Group therapy.
- Addiction treatment and substance use disorder treatments.
- Inpatient behavioural services.
- Emergency mental health services.
- Family counselling.
- Testing and diagnostic services.
- Intensive outpatient programs.
- Partial hospitalization.
It is important to check with your specific insurance provider to understand the types of therapy covered by your plan, as well as any requirements or limitations. Some insurance companies provide an online portal or directory that allows you to search for in-network therapists and filter by specialty or location. Additionally, your human resources department may be able to clarify your mental health benefits if you have insurance through your employer.
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Finding a therapist who takes insurance
Therapy can be expensive, with the average cost of a session being over $180. Many people are kept from accessing therapy due to the cost, but insurance can help to cover therapy costs. Many insurance plans cover therapy services to some extent, but it can be challenging to find a therapist who takes insurance. Federal law requires health insurance provided by large employers or via the health care marketplace to cover mental health treatment at levels similar to those at which it covers physical health. However, fewer than 40% of therapists are in-network with even a single health plan.
If you're looking for a therapist who takes your insurance, the first step is to understand your health plan. Log into your insurer's online portal or call the number on the back of your health insurance card to confirm whether your policy covers mental health treatment and whether there are any requirements you need to know about. You can also find information about your health plan coverage, including copays, printed on your card or through your insurance provider's app. It's important to understand if specific treatment modalities, types of therapy, or medications are not covered.
Once you know the details of your plan, you can start looking for a therapist who is in-network with your insurance provider. You can access an online directory of insurance companies or see a list of all the providers in your network on your insurance's website. You can also call your insurance company to determine if a therapist is in-network. If you get your insurance coverage through work, you might consider asking your human resources department to clarify your mental health benefits. Keep in mind that therapists who are in-network with your insurance provider will bill your insurer directly, and you'll only be responsible for your copay or coinsurance fee after your deductible.
If you can't find an in-network therapist who is accepting new patients, you may have more options if you're open to working with a therapist via telehealth. Telehealth can open up a larger universe of potential providers, as you can see anyone licensed in your state. You may also consider asking about a sliding scale fee option, which means your cost for treatment will be based on what you can afford.
There are resources available to help you find a therapist who takes your insurance. For example, Grow Therapy connects clients, therapists, and insurance companies to make mental healthcare simple to access. They have an easy-to-use platform that allows you to browse therapists in your state that take your insurance and book sessions and consultations online.
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Frequently asked questions
A therapist is classified as a healthcare provider with medical insurance.
Many insurance plans cover some amount of therapy. Individual insurance plans typically include coverage for therapy and mental health services. However, it is important to check your specific plan as some have more restrictions or may require you to pay part of the cost.
You can log into your insurer's online portal or call the number on your health insurance card to confirm whether your policy covers mental health treatment. Your health insurance plan's website should also contain information about your coverage and the costs you can expect.
If your insurance does not cover therapy, there are still ways to access affordable mental health care. These include employer benefits, community health centres, state and federal assistance, and online therapy platforms.
The average cost of therapy with insurance typically ranges from $20 to $50 per session, depending on your insurance coverage plan.
