Does Insurance Cover Psychiatrists?

Many health insurance plans cover psychiatric care to some extent, but what exactly is covered depends on your plan, provider network, and deductible. Understanding whether your insurance covers psychiatrist visits, what plans typically pay for, and how to check your benefits may help you choose the right services. We'll also share what to do if your mental health coverage is limited.

Does insurance cover psychiatrist visits?

You might assume that your health insurance will automatically pay for any psychiatrist visits, but that's not necessarily true. Most major health plans cover some behavioral health treatment under essential health benefits. However, the services and the exact amount covered depend on the specific plan. 

Examples of behavioral health services that may be covered by insurance include: 

• Evaluations
• Medication management
• Ongoing appointments with a psychiatrist 
• Lab work, such as blood tests to monitor medications 

The number and types of covered services typically vary by insurance plan. For example, one plan may cover ongoing visits with a psychiatrist, while having a different cost coverage structure for lab work. 

Even when an insurance company covers a service, you may still have out-of-pocket costs. Many plans have a copay, which is a fixed cost for a specific service or medication. Your plan may also include an annual deductible that you must reach before coverage kicks in. 

Some plans include coinsurance as an alternative to a fixed copay. This is a percentage of the cost that you pay out of pocket. For example, if your coinsurance is 20% and a psychiatrist charges $300 for an evaluation, you might need to pay $60 while your insurance covers the rest. 

Read your policy carefully and make sure you understand your coverage, including what you're responsible for out of pocket. 

*Based on finalized paid psychiatry visits with a copay. Insurance availability, coverage, and costs vary by state, plan, provider network, and provider availability.

What affects psychiatric coverage?

The type of plan is one of the biggest factors that affects mental health insurance coverage. There are a few common plan structures: 

• Health maintenance organizations (HMOs)
• Preferred provider organizations (PPOs)
• Point of service (POS) plans
• High-deductible health plans (HDHPs)

Each type of plan structure handles specialist referrals and networks differently. For instance, an HMO may require a referral to see a psychiatrist, while a PPO usually does not. Some plans also only cover mental health services from in-network providers. Others may pay for at least a portion of out-of-network visits. 

Your location matters, too. If there aren't many psychiatrists in your area or your plan has a limited network, finding an in-network provider could be tricky. Online psychiatry could give you more flexibility by letting you access care from a psychiatrist remotely. That's helpful if there are no nearby in-network providers or if their availability doesn't fit your schedule.

Whether you choose an in-person or online provider, make sure they have the proper licensing for your state. Insurance coverage generally applies to treatment from licensed mental health professionals. This means services provided by unlicensed sources typically aren't covered. 

Your deductible may also affect how much you pay, with costs potentially going down once you meet it. 

What's the difference between in-network and out-of-network psychiatric care?

In-network mental health providers have a contract with the insurance company. They've typically agreed to offer their services at a pre-negotiated rate, which may reduce out-of-pocket costs. 

On the other hand, out-of-network providers don't have a contract with the insurer. Depending on your mental health benefits, you may need to pay for care from these professionals upfront and seek reimbursement from the insurance company. Your out-of-pocket costs could also be higher because out-of-network providers haven't agreed with the insurer. 

Before you book an appointment with a psychiatrist, check their network status. While their office may be able to provide this information, it's often best to reach out to your insurance provider directly. They'll have the most up-to-date coverage information. 

How can you check if your plan covers a psychiatrist?

You don't need to guess whether your plan covers mental and behavioral health services. Check by calling the number on the back of your insurance card. If you don't have one, you may need to reach out to your employer for contact information. 

Ask your insurer if your plan specifically includes psychiatric and behavioral health services, not just general mental health coverage. For example, some plans may automatically cover appointments with a licensed therapist but require a referral for psychiatric services. 

The cost of either may be determined by your insurance coverage. Ask about your copay and deductible amounts. While your insurance company may not be able to give you an exact cost in advance, they should be able to estimate what you might owe. 

You should also confirm your provider's network status before scheduling an appointment to avoid surprise costs. 

What is mental health parity?

The Mental Health Parity and Addiction Equity Act of 2008 is a federal law that generally requires insurance companies to cover mental health and substance treatment in the same way they cover treatment for physical conditions. 

That means your insurer typically can't charge a higher deductible for mental health treatment or place a stricter limit on it than they do for medical care. The coverage has to be comparable. 

Thanks to this law, psychiatric care may be more accessible than you might expect, especially if you already have medical coverage. 

What if insurance does not cover psychiatric care?

Don't feel discouraged if your insurance plan doesn't cover treatment for mental health conditions. That doesn't mean that care is out of reach. 

The average psychiatrist cost without insurance generally ranges from $100 to $300. If you have a health savings account (HSA) or a flexible spending account (FSA), you may be able to use these funds to offset these expenses.

BetterHelp offers affordable and accessible psychiatry services. For those looking to use insurandce, ,any psychiatric providers are in-network with most major insurers. Eligible members pay an average copay of only $26 per session.

*Based on finalized paid psychiatry visits with a copay. Insurance availability, coverage, and costs vary by state, plan, provider network, and provider availability.

Insurance coverage for psychiatric services varies widely by plan, deductible amount, provider network, and other factors. Checking with your insurer is the most reliable way to know what your plan includes.

BetterHelp’s psychiatry and medication management care addresses a range of mental health needs (e.g. anxiety, depression, ADHD, etc.) by connecting members to providers who prescribe from a defined list of commonly prescribed medications (excluding controlled substances)*. 

*Medication availability and coverage may vary by member location, clinical appropriateness, and individual pharmacy/insurance benefits. Prescribing decisions are made by the treating clinicians. We do not guarantee that any specific medication will be prescribed or covered by a member’s insurance plan. Controlled substances are not prescribed.