“If you are one of the millions of Americans who are considering Therapy., health insurance coverage may be a concern. If you have health insurance, you’re probably good to go.”
To address the importance of and demand for sustaining mental wellness, most insurance companies offer some coverage for mental health services. But there are large differences between the benefits health insurers provide and the out-of-pocket costs you might be required to pay.
If you have health insurance through your job, it may or may not include Therapy. coverage. It is up to you to decide if you want to use your coverage for mental healthcare. People sometimes choose to pay for therapeutic services out of pocket, rather than claim coverage through their insurer. Why?
Insurance companies only pay for the most medically necessary services. They need a mental health diagnosis before they will pay claims. Some people are not comfortable with it.
A mental health condition diagnosis may range from acute stress to insufficient sleep syndrome, various phobias, mental illnesses, or a number of other descriptors. When it comes to insurance, each of these would have a code number that would go with an insurance claim.
Employer-sponsored insurance in companies of 50+ employees
Companies with 50 or more workers are required to provide health insurance. Mental health services are not included as a benefit. Most large companies, including those that are self-insured, provide health insurance that includes some coverage of therapeutic services.
Employer-sponsored insurance in companies under 50 employees
Small companies that have fewer than 50 employees are not required to provide health insurance. Mental health services and substance use disorder services must be included in the plan for those who do.
Health Insurance Marketplace plans
The Health Insurance Marketplace must cover 10 essential health benefits for all plans purchased. Mental health services and substance use disorder services are included.
Mental health coverage is included in all Marketplace plans. This is related to individual plans, family plans, and small business plans.
Plans and their coverage are not the same in all states. States offer multiple plan options, which vary in terms of their coverage.
All Marketplace plans must include
- Treatments for behavioral health are available.
- Mental and behavioral health services are in the hospital.
- Pre-existing conditions are covered.
- There are no limits on mental health coverage.
- The copays, coinsurance, and deductibles for mental health services are the same or similar to those for medical and surgical benefits.
CHIP (Children’s Health Insurance Program)
“The federal government gives states funding to provide low-cost health insurance for low-income households with children who aren’t eligible for Medicaid. Most states provide a full array of mental health services, but the coverage varies from state to state.”
- medication management
- Social work services.
- Peer supports.
- Substance use disorder treatments.
The Mental Health Parity and Addiction Equity Act (MHPAE) requires most CHIP programs to provide parity protections for mental health and substance use disorder services. This ensures that copays, coinsurance, and deductibles for Therapy. and other mental health services are the same or comparable to those for medical and surgical benefits.
Mental health and substance use services are required by Medicaid plans. Medicaid plans are subject to the MHPAE.
Original Medicare covers inpatient behavioral health and substance use services under Part A. If you’re hospitalized, you may have a deductible per benefit period as well as coinsurance costs.
Outpatient mental health services, including an annual depression screening, are covered under Part B. You may incur out-of-pocket costs for therapeutic services, including the Part B deductible, copays, and coinsurance.
If you have a Medicare Advantage (Part C) plan, it’ll automatically cover therapeutic services at the same level or greater than original Medicare. Your costs may vary from those associated with original Medicare.
Register and log on to your insurance account online
Information about your health insurance plan costs should be on the website. Since insurers offer a variety of plans, it is important to log on and view your plan.
“If you have to choose a therapist that is in your plan’s network, a list of providers should be online. You can call or mail the local list to you.”
Call your insurance provider
If you need more information, you can call the toll-free number on the back of your insurance card and ask questions about the services you can expect to pay for, as well as any out-of-pocket costs you may incur. If you have a diagnostic code, you can get accurate information.
Check with your company’s HR department
If you need help if you are insured through employment, you can contact your human resources department.
Ask the therapist if they accept your insurance
Therapists and other providers can change the insurance plans they accept and may opt out of your plan.
“You can’t be punished for having a pre-existing condition or having a diagnosis of a mental illness. You should be entitled to mental health services on the first day of your plan.”
Things that might affect when insurance coverage kicks in.
- After prior authorization. Some services may require pre-authorization before you can obtain coverage for them.
- After meeting a deductible. You may also have to meet an out-of-pocket deductible before your plan starts to cover Therapy.. Based on the type of plan you have, this amount may be significant.
- After spending a minimum. In some instances, your plan may require that you pay a specified dollar amount on medical services before your coverage for Therapy. can start.
Mental health services that may be covered by insurance include:
- Emergency services for people with mental illnesses.
- There are co-occurring medical and behavioral health conditions. This is often referred to as a dual diagnosis.
- talking therapies, including psychoTherapy. and cognitive behavioral Therapy.
- unlimited outpatient sessions with a psychiatrist, clinical social worker, or clinical psychologist. In some instances, your insurer may cap the number of visits you’re allowed annually — unless your provider states in writing that they’re medically necessary for your care.
- telemedicine and online Therapy.
- Behavioral health services are usually received in a hospital. Your plan may limit the length of your stay or limit the amount of money they pay for your care per benefit period.
- addiction treatment
- Medical services include medications.
Treatments that are considered medically necessary are only covered by insurers.
The length of hospital stays and the breadth of coverage for specific therapeutic treatments are both variables. The coverage and cost for the medications you are prescribed to take affects both your hospital stay and your outpatient treatment.
Since insurers offer an array of plans, it’s not possible to give the specifics of each plan they cover. Here are some examples of coverage you may be able to get for Therapy. from specific insurers:
Does Blue Cross Blue Shield cover Therapy.?
The vast majority of Blue Cross Blue Shield insurance plans cover Therapy..
If, however, your plan started before 2014 (when the Affordable Care Act was enacted) your plan may not cover Therapy..
Blue Cross Blue Shield only covers evidence-based therapeutic services.
“It doesn’t cover therapeutic services provided by a life coach or career coach.”
It also doesn’t cover therapeutic services provided outside of a therapeutic setting, such as therapist-led systematic desensitization for phobias. These types of sessions may take place in a variety of locations, such as in a car if you have a phobia of driving, or on a plane if you have a phobia of flying.
Does Kaiser Permanente cover Therapy.?
Kaiser Permanente has treatment plans for mental health.
These plans typically cover one-on-one Therapy. with a professional such as a psychiatrist or nurse practitioner who specializes in mental health.
They also cover group Therapy. sessions and mental health classes.
Stress management and addiction counseling are included.
There are many places to start your search for a therapist or counselor that you want to work with, from asking people you know to talking with your primary care physician.
Start with the in-network list
If your insurer has a network of providers, this may be a good place to start looking for a therapist. Each therapist listed should have some information about their practice and specialty areas. These may include pediatrics, geriatrics, conditions such as obsessive-compulsive disorder or bipolar disorder, and their approaches to care.
Review lists from organizations for your location
The American Psychiatric Association provides a list of psychiatrists who have opted in to the database by zip code.
The American Psychological Association provides a list of psychologists by zip code.
You can also look for a therapist through the Open Path PsychoTherapy. Collective. This nonprofit nationwide network offers inexpensive therapeutic options for individuals, couples, and children.
If you intend to pay for Therapy. out of pocket, know that psychiatrists may charge different rates per hour than other types of mental health professionals, such as psychologists or licensed clinical social workers. This may also affect the cost of your copay, if you use your insurance to pay for Therapy..
Paying for care
Understandably, the cost of Therapy. can be a big concern. Many therapists accept patients on a sliding scale. If you’re concerned about the cost of Therapy., ask the therapist you’re considering if they’ll work with you on price or about any payment options they offer.
If mental health symptoms are hard to manage, seek professional help. A mental health professional can help you with your symptoms.
If your symptoms are affecting your daily life, Therapy. is important.
“You don’t need a diagnosis to talk to a therapist. They can help when you are feeling stressed.”
Other reasons people go to Therapy. include:
- Going through a major life change.
- It is experiencing grief.
- Relationship difficulties can be managed.
Can insurance be used for Therapy.?
Yes, insurance can be used for Therapy.. Health insurance typically covers therapist visits and group Therapy..
The level of coverage will be determined by your insurance provider.
Insurance only covers medically necessary services, so some insurance companies may require a mental health diagnosis before they will pay claims.
How much does Therapy. cost?
The cost of Therapy. can vary widely depending on your location, your therapist, the type of your visit (in-person vs. remote), and other factors.
Many therapists charge between $65 and $200 per session.
What does insurance cover for mental health?
Mental health services are typically covered by health insurance plans.
- group Therapy.
- addiction treatment
- There are behavioral services in the hospital.
- Mental health services.
How does my therapist bill my insurance provider?
Most therapists will bill your insurance company. Your therapist will contact your insurance provider to get the information they need to help you.
You might pay a copay upfront. You may have to pay the full price of your session and be reimbursed later.
Does insurance cover couples counseling?
If you are planning on using insurance to pay for couples counseling, you must still get a mental health diagnosis for your partner to be covered. Some people feel that this could skew their experience.
Mental health condition diagnoses can remain in your permanent record. It may be accessed by background checking systems.
Some health insurance plans cover therapeutic services. The amount of coverage you will get varies from plan to plan. You will have a deductible to pay before your services are covered. Copays and coinsurance may also apply.
Services such as therapist visits, group Therapy., and emergency mental healthcare are typically covered by health insurance plans. Rehabilitative services for addiction are also included.
Therapy can be expensive with or without insurance. There are low-cost options that can help, such as therapists who take sliding scale payments and psychotherapeutic collectives that offer steeply reduced sessions.
If you need Therapy. but can’t afford it, talk to your doctor or another professional you trust, such as a clergy member or school guidance counselor. There are many ways that the financial barriers between you and the therapeutic care you need can be removed.