Using Insurance Benefits for Therapy: What You Need to Know
Starting therapy can feel overwhelming, especially when you’re also trying to understand your insurance coverage. Using your insurance benefits for therapy can make it much more affordable and accessible. For many people, this is the only way they are able to go to therapy, so it’s a really valuable resource.
Does Insurance Cover Therapy?
Most commercial insurance plans do cover mental health therapy, but what and how much they cover varies based on your carrier, your specific plan, and whether the therapist you choose is In Network with that plan. There are some things you need to know to before you try to use your benefits:
First, you must have a qualifying mental health diagnosis in order for insurance to pay for services. This diagnosis will remain in your insurance records even after you end therapy. Your therapist will conduct an assessment during your first session to determine if you qualify for a diagnosis, and if so, what diagnosis you meet criteria for. If you don’t meet criteria for a diagnosis, you may not be able to use your benefits to cover therapy sessions.
Most companies cover both in person and virtual/telehealth therapy.
Most plans cover an initial diagnostic session and ongoing therapy, although some carriers do limit how many sessions you can have in a year.
The easiest way to know what your plan covers is to review your benefits and contact your insurance company directly to determine what is covered and what you can expect to pay per session.
Common Terms to Describe Therapy Costs When Using Insurance
Even when therapy is covered, there are often still be out-of-pocket costs.
Copay: A copay is a fixed amount you pay for each session. This amount is usually the same throughout the year, although some plans do change the copay after a certain number of sessions or once your Out of Pocket Maximum is met. For example, if you have a $30 copay, you will pay $30/session.
Deductible: A deductible is the amount you may need to pay before insurance begins covering services. This means you pay the full contracted rate (the rate your insurance has agreed to for your therapist) until you have paid the total deductible amount. Once you reach this amount, most plans shift to a coinsurance or copay amount. For example, if you have a $2000 deductible and the contracted rate for the session is $150, you will pay $150/session until you meet your deductible. Most plans have a deductible that applies across all medical services, so you may reach this deductible faster if you have additional medical expenses throughout the year.
Coinsurance: Coinsurance is a percentage of the session fee you may owe after meeting your deductible. For example, if the contracted rate for the session is $150 and you have a 20% coinsurance, the session fee you would pay would be $30/session.
Understanding these terms can help you plan financially and avoid surprises.
Questions to Ask Your Insurance Company
When calling your insurance company, these are some helpful questions to ask:
Is outpatient therapy covered under my plan?
Is telehealth therapy covered?
What is my copay/coinsurance for therapy sessions?
Do I have a deductible?
Do I need prior authorization?
How many sessions are covered?
Do I have Out-of-Network benefits? If so, what are they?
You can often find this information on your insurance portal as well.
In-Network vs. Out-of-Network Therapy
In-Network: An in-network therapist has a contract with your insurance company and typically offers lower out-of-pocket costs. For example, I am In-Network with Aetna and the United family of companies (in Tennessee, Utah, and Florida), so clients with those insurances seeing me can expect to pay their deductible/copay/coinsurance only.
Out-of-Network: An out-of-network therapist does not bill your insurance directly, but some plans may reimburse part of the cost. The therapist can provide a Superbill to be submitted to your insurance for reimbursement. Some companies make Out-of-Network reimbursement really easy, but some are more complex. In the more complex situations, using a company like Thrizer may be worth exploring.
If you have out-of-network benefits, you may be able to submit claims for partial reimbursement.
Therapy Is Worth Exploring
If insurance feels confusing, you are not alone. Most people feel overwhelmed by the process. You do not have to understand everything perfectly before you get started. Sometimes the first step is just reaching out, asking questions, and gathering information. Therapy can be a meaningful investment in your mental and emotional well-being, and support is often more accessible than it first appears.
Ready to Get Started?
If you are located in Tennessee, Florida, Utah, or Ohio and are considering online therapy, I’d be happy to help you explore next steps.