How to Get Pre-Authorization for Therapy

When using health insurance to pay for therapy, your insurance plan might require pre-authorization before starting treatment. 

Pre-authorization for therapy is a process in which your insurance company reviews a proposed medical service to determine whether it meets the plan’s requirements for coverage. 

Understanding whether you need pre-authorization, and how to get it, can help you avoid unexpected costs and reduce delays in starting care. Learn how the process works, what information you may need to provide, and what to do if your request is denied.

What is a pre-authorization for therapy?

Pre-authorization for therapy is a process in which an insurance company reviews a proposed treatment or service before it takes place. The insurer may evaluate whether the service meets its medical necessity criteria and other coverage requirements.

You may also see this process called prior authorization or precertification. Although insurers may use these terms somewhat differently, they generally refer to obtaining approval or a coverage review before receiving a particular service.

Pre-authorization requirements vary by insurance plan, provider network, and type of mental health care. Some plans may not require prior authorization for routine outpatient therapy, while others may require it for certain services or after a specific number of sessions.

It’s also important to understand that authorization is not a guarantee of payment. Your insurer may approve a service but later determine that a claim does not meet other coverage requirements. You may still be responsible for deductibles, copayments, coinsurance, or services your plan excludes.

How to know if your insurance requires pre-authorization for therapy

Before scheduling your first appointment, check whether your plan requires authorization for the type of mental health care you intend to receive.

You can start by:

• Checking your member portal: Log in to your insurance company’s website or app and review your mental health benefits, coverage documents, and prior authorization requirements.
• Calling your insurance company: Use the member services number on your insurance card. Ask whether your planned treatment requires pre-authorization and what steps you need to take.
• Contacting your therapist: Ask whether the provider’s office handles authorization requests and whether they can verify your benefits before treatment begins.

Requirements may differ depending on the service:

• Outpatient therapy: Routine individual, couples, or family therapy may have different coverage rules depending on your plan and the type of service.
• Intensive outpatient programs (IOPs): These structured programs provide more frequent treatment than standard outpatient therapy and may require prior authorization.
• Inpatient mental health treatment: Hospital-based psychiatric care may involve separate authorization and utilization review requirements.
• Psychological testing and assessments: Some evaluations may require authorization or a referral, depending on the purpose of the assessment and your plan’s rules.

When contacting your insurer, ask about both authorization requirements and the benefits available for your specific service. This can help you understand the steps you need to take before beginning care.

How to get pre-authorization for therapy

If your insurance plan requires prior authorization, the following steps can help you navigate the process.

1. Confirm your insurance requirements

Contact your insurer to verify whether your planned therapy requires authorization. Ask whether you need a referral from a primary care provider, whether your therapist must be in network, and whether the request must be submitted before your first appointment.

Confirming these details early can help prevent avoidable delays or unexpected expenses.

2. Find an eligible in-network therapist

Check your plan’s provider directory or ask your insurer for a list of in-network mental health professionals. Then confirm that your chosen therapist accepts your insurance and can provide the type of care you need.

Ask your therapist whether they submit prior authorization requests on behalf of clients. Some providers handle the process directly, while others may ask you to contact your insurer.

3. Gather the required information

Your insurer may request information about your planned treatment, your provider, and your clinical needs. Depending on the service, this could include:

• Your insurance member ID and policy information
• Your therapist’s name, credentials, and provider identification number
• The proposed service and relevant billing or procedure codes
• The anticipated treatment frequency and duration
• Clinical documentation supporting the need for treatment

Your therapist can help identify the appropriate documentation and submit clinical information when required.

4. Submit the authorization request

Follow your insurer’s instructions for submitting the request. Your therapist may submit it through an online provider portal, by phone, or through another designated process.

If you need to submit the request yourself, ask your insurer which forms are required and how to provide supporting documents. Keep copies of your submission and note any confirmation or reference number.

5. Follow up on your request

Ask when you should expect a decision and how you will be notified. If you haven't heard back within the expected timeframe, contact your insurer to check the status.

Before beginning treatment, confirm whether authorization is required and whether you need to wait for approval. If you need mental health support while the request is being reviewed, ask your provider about available options and any associated costs.

Questions to ask your therapist:

• Do you accept my insurance and participate in my plan's network?
• Can your office submit the prior authorization request for me?
• What clinical information or paperwork do you need from me?
• Can I begin therapy while the request is pending?
• How will we know when authorization is approved or additional sessions are needed?

How long does therapy pre-authorization take?

The time required for therapy pre-authorization depends on your insurer, the type of service, and whether the request includes all the necessary information. Some requests may be reviewed within a few business days, while others can take longer.

Ask your insurer for its expected review timeline and whether you can check the status online. Incomplete documentation or requests for additional information may delay a decision.

If you need treatment urgently, tell your insurer and therapist. Some plans have expedited review procedures for qualifying urgent requests, although eligibility and timelines vary. If you're experiencing a mental health crisis, text or call 988 for 24/7 support.

What happens after therapy is authorized?

If your request is approved, your insurer may authorize treatment for a specific period, a set number of therapy sessions, or another defined scope of services. For example, your plan may approve a limited number of therapy visits before requiring another review.

Read the authorization notice carefully. Confirm the approved services, effective dates, session limits, and any conditions you must meet. Also verify your deductible, copayment, or coinsurance and whether your therapist remains in network.

You may need additional authorization if you reach your session limit, need a different type of treatment, or continue therapy beyond the approved period. Your therapist may need to submit updated documentation explaining why ongoing care is appropriate.

Keep track of your remaining authorized sessions and contact your insurer or therapist before your approval expires. An authorization for one provider or service may not automatically apply to another.

What if pre-authorization for therapy is denied?

A denied request doesn't necessarily mean you cannot receive therapy. Start by asking your insurer why the request was denied and whether the decision was based on missing information, eligibility requirements, medical necessity criteria, or another coverage rule.

You can then take the following steps:

1. Review the denial notice. Look for the reason for denial, any applicable policy provisions, and instructions for requesting a review.
2. Check for errors or missing information. Confirm that your provider submitted the correct information and that the request matches your plan's requirements.
3. Ask your therapist about additional documentation. Your provider may be able to submit clinical records or clarification that addresses the insurer's concerns.
4. Appeal the decision if appropriate. Health plans generally provide an appeals process for certain adverse coverage decisions. Follow the instructions and deadlines in your denial notice.

Ask your insurer whether you can request an expedited appeal if a delay in treatment could seriously affect your health. You can also ask your therapist about alternative treatment options and their costs while you explore your coverage options.

What happens if you start therapy without pre-authorization?

If your plan requires prior authorization and you begin treatment without obtaining it, your insurer may deny the claim or pay less than expected. Depending on your plan and provider agreement, you could be responsible for some or all of the cost.

In some circumstances, an insurer may allow a retroactive authorization, but you shouldn't assume this will be possible.

Before starting non-emergency therapy, confirm whether authorization is required, who must obtain it, and whether approval must be in place before your first appointment. If you've already started treatment, contact your insurer and therapist as soon as possible to discuss your options.

How online therapy and pre-authorization may work

Insurance requirements for online therapy can differ from those for in-person care, but virtual treatment isn't automatically exempt from prior authorization.

Your plan may cover telehealth therapy under the same general benefit structure as in-person sessions, or it may have separate requirements. Coverage can depend on the provider's network status, the type of service, and applicable plan rules.

Before booking online therapy confirm that your plan covers virtual mental health care and ask whether pre-authorization is necessary. If you're considering an online therapy platform like BetterHelp, verify whether the platform or individual therapist participates in your plan and whether you can use your insurance for the specific service.

BetterHelp is in-network with most major health plans including United, Cigna, and Aetna. You can check to see if your insurance covers online therapy by answering a short quiz tailored to your preferences and goals for therapy. 

Some online therapy services operate outside traditional insurance billing and authorization processes. In those cases, you may need to pay directly rather than submit claims through your insurer. Review the service's payment policies and your plan's out-of-network benefits before making a decision.