Is Therapy Covered By Insurance Or Do I Have To Pay?
By Sarah Fader
Updated January 08, 2020
Reviewer Dawn Brown
"Does health insurance cover therapy"? One of the first things people usually think about when it comes to therapy is how much it costs and how they will pay for it. You may be asking yourself, "Is therapy covered by health insurance?" The answer to whether therapy is covered by health insurance -- is often left up to the discretion of small health insurance plans. The good news is -- that mental health care is becoming just as affordable as life insurance, home insurance, and even car insurance (in some cases).
There has also been legislation enacted to require that health insurance covers therapy and behavioral health treatments for mental illness. This legislation falls under the Mental Health Care and Parity Act (MHPA). Under the Mental Health Parity Act, larger health insurance companies and employers (that have more than 50 employees) are required to provide health insurance coverage where plans cover medical health and mental health services. This health insurance coverage must also provide mental health and substance abuse coverage for around the same out-of-pocket costs.
In this article, we discuss mental health care insurance, where to find your mental health coverages in your health insurance policy, and how to get mental health care insurance coverage that is just as affordable as life insurance or car insurance.
Health Insurance Coverage for Mental Health Care
There are many options available for paying for mental health treatment. What's covered and what health insurance doesn't cover can be confusing at first. This is especially true in cases where insurance plans cover mental health care services like psychotherapy and counseling. The Mental Health Parity Act is a component of the Affordable Care Act that requires large health insurance providers and health plans to provide equal coverage for mental illness (including substance abuse coverage and treatment).
Please keep in mind that you can always contact your health insurance provider directly if you have questions about what your health insurance plans cover. You can work with your health insurance provider directly to get information on health coverage for therapy and other mental health services. can work with their secretarial staff directly. They will be able to answer questions specific to their health insurance plans. The goal of this article is to help you figure out if you have mental health coverage under your health insurance plan.
Does Insurance Cover Therapy?
Unfortunately, there are no fast and easy answers to whether your health insurance plan will cover your therapy sessions. Your health insurance provider will tell you whether they cover therapy and under what conditions they will cover it. The law doesn't require small health insurance companies with fewer than fifty employees to have health insurance cover the cost of therapy. A therapist's office can also help with these questions.
You can always contact your therapist in advance to see if they accept health coverage for mental health care services. Under the Affordable Care Act and Mental Health Parity Act, employers with more than fifty employees are required to provide members with equal access to health plans for medical care, mental illness and mental health care, substance abuse, and eating disorders. If you're an employee of a large employer who has more than fifty employees, check with your health insurance benefits department to verify what level of mental health coverage you have.
Common Insurance Coverage Concerns
There are a lot of companies who aren't governed by the Affordable Care Act or the Mental Health Parity Act that choose to provide mental health coverage for their employees. Many health insurance plans do cover the cost of mental health and substance abuse treatment. If your group health insurance plan provides coverage for mental and behavioral health services, it's up to you to find out your level of mental health coverage.
Before seeing a therapist, it's important to see if the provider takes your health insurance. One way to find out is give you provider the details shown on your insurance policy to learn if they accept your health insurance. Another easy way to find out mental health coverage you have (including in-network, and out-of-network providers is to call your health insurance provider and ask if they provide health coverage for mental health and substance abuse related services. If you're wondering about the health insurance plan you have and what it covers -- you can contact your insurer and inquire on the phone. Here are some questions to ask your health insurance company when you have them on the phone:
- Are there specific services that my health insurance plan doesn't cover?
- Does my health insurance plan cover therapy?
- Does the therapist I want to see accept insurance and are they in the network covered by my health insurance plan?
- Which therapists do take my insurance for mental health related services ?
- Where can I find a list of therapists who accept my insurance for therapy and other mental health services under my health insurance plan?
- How many therapy sessions do my health plans cover per year?
- Do I have a deductible to pay before my health plans cover services under my health insurance plan?
- Is there a copay required by individual or group health insurance plans?
- Do I need a referral from my primary care doctor under my health insurance plan?
- Can I bundle my medical health insurance plans with other insurance options like -- mental health coverage, renters insurance, auto insurance, or pet insurance to receive a discount?
These are a few of the questions you can ask your health insurance provider. Remember, as a consumer you have the right to know what your insurance plans cover. Knowing what your insurance covers can help you determine the course of your mental health treatment.
Below are several more things to take into consideration when using health insurance for mental health coverage. Some of them may provide useful questions and answers as well.
An out-of-network provider is a provider who accepts health insurance coverage as a form of payment. In this case, that health insurance partially covers mental health care. Although they may accept insurance for mental health coverage, an out-of-network provider is "outside" of your health plans network. When you choose an out-of-network provider there's a limit to what you health insurance plans cover. Consider the added costs of managing your everyday insurance services like auto insurance and the cost of your other health plans when choosing your provider.
Sometimes you'll find a great therapist and ask them if they accept your health insurance. When you contact your insurer -- they may say they don't take your insurance, but if you have out-of-network benefits, you can see them and get reimbursed by your insurance company.
However, using out-of-network health insurance coverage also means that you have to pay a significant amount of money to your therapist upfront (in the form of a copay) before health plans will cover the remaining costs of therapy. Typical health plans pay for between 60 -80% of out-of-network fees. Health plans in the US require that you pay for the costs of your copay, and out-of-network costs, before your health insurance covers therapy.
Therapy insurance can be hard to find, and that's why people sometimes opt to see therapists who are out-of-network. If you have $200 to pay for a therapy session up front, then this option could work for you. But it can become expensive, and it takes a while for your insurance to reimburse you for the sessions you paid upfront for, which is frustrating.
Health Insurance Deductibles
Finding out what your health insurance covers for mental health treatment can be overwhelming. you can compare the process of finding the best mental health care insurance, to finding the best renters insurance or the best life insurance. The process of finding the best mental health care insurance is just as important as shopping for the best deductible on your life insurance, renters insurance, or auto insurance policy. It is important to pay attention to what your mental health care health plans cover (before and after the deductible). If you're unable to choose between plans, insurance reviews can give you a better perspective on how people feel about your choice of mental health care insurance providers. When you figure out that your insurance covers behavioral health and mental health care -- there's still more work to do.
For example, you may have a deductible that you're required to pay in advance of getting treatment for a mental illness or substance abuse coverage. We talked about deductibles earlier in relation to out-of-network health plans. A reasonable example is that your insurance may have a deductible of $2,000 for out-of-network services related to mental illness.
Even though your therapist takes your insurance plan, you have to pay for each session out-of-pocket until your health plans reach a balance of $2,000 before the insurance company covers the cost of therapy. This could easily make therapy unaffordable. If you are not looking for a long-term therapy plan, you may have to pay thousands upfront because of your deductible. Treatment costs for mental illness can vary depending on the severity of symptoms. That's why many people prefer to pay for cheaper therapy (such as online therapy) upfront, since it costs less than the options you can get with insurance.
It's no wonder that some people are finding therapists who work on a sliding scale as an alternative to using health insurance to cover therapy. As mentioned above, if your health insurance has a high deductible, even if you find a therapist who takes your insurance, you have to pay them out of pocket until you reach your health plans deductible.
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Low Cost Clinic
Another option for finding affordable mental health care -- is to find a low-cost clinic. Under the Affordable Care Act, some mental health care facilities are designed for people who have lower incomes (where you can pay a sliding scale fee for therapy sessions). There are also universities that have programs where graduate students are training in psychology under the American Psychological Association (APA) guidelines that provide low-cost services under the Affordable Care Act. Students participating in these programs that are governed by the standards of the American Psychological Association see clients as a part of their clinical training. This means that in many cases, you can get therapy at a college or university for a meager cost (if not free).
Insurance May Include Flexible Spending of Health Savings
Another option to pay for therapy is a health savings account or flexible spending account. A health savings account is a savings account that allows users to save money tax-free to pay medical expenses ONLY. Needing counseling or therapy sessions is a good reason to dip into this account, and you get to use it at your own discretion.
Parity Laws Explanation
The parity laws have some effect on the benefits for therapy and provides special requirements for what health insurance plans must cover. Mental health parity laws don't always require insurance companies to cover therapy in all situations. The parity laws require health insurance to cover mental health conditions on equal terms as physical health. Parity laws stipulate that large group health insurance cover mental health care services and medical health care services equally. What this means is that there can be no differing amounts in what your medical and mental health plan cover.
The Affordable Care Act (ACA) and the Mental Health Parity Act have the same goals when it comes to deciding what your health plan covers. The goal of both programs is to make sure that plans cover (and health insurance covers) people in need of affordable mental health care insurance. Services for mental health care are now as affordable as those that cover people for life insurance, renters insurance, home insurance, and car insurance. If you have questions about what your health insurance or mental health insurance plan covers under the Affordable Care Act, or MHPA review the terms outlined in your insurance policy, or contact your insurance provider directly.
Online Therapy Can Help
BetterHelp is an option to consider. It is online therapy, or a network of licensed counselors available to you anywhere you have an internet connection. BetterHelp is not always the best option, but for many people it is. Prices are billed at affordable out-of-pocket rates, so it is cheaper for people who do not have insurance, or for people who have insurance but also have a high deductible.
BetterHelp is convenient and secure as well. It is completely anonymous if you wish, and can be accessed from the privacy of your home. We encourage you to do your research on financing therapy, and we hope that BetterHelp is part of your research. Below are two counselor reviews for you to help your search, from people experiencing a range of life's challenges.
"I've always struggled with going to appointments. Although I don't have to pay in Germany for mental health care, I choose to use BetterHelp because it's easier for me to have counseling sessions and I can be in the comfort of my own home! I am very happy with Daniel Merchant's help so far, I feel very understood, and for the first time in my life I don't feel like i'm incurable. I don't get treated as if something is wrong with me [but like] I have challenges I face that can get solved with methods that I am comfortable with. I can totally recommend it, it's totally worth the money!"
"I had some trauma when I was younger that was severely affecting my life and my relationships in a negative way. I also didn't have even the kind of money to afford this service for a long period of time. But Danny took the time and discussed treatment options for PTSD that I did not know much about before. I had tried different forms of therapy with limited success, but being able to write out my feelings, thoughts, and experiences allowed me to express myself in a way that I would not feel comfortable doing while sitting one on one with someone in the same room with me. Maybe that's a sign of me being on the older side of the texting/dm/instant message generation, but the messenger discussion was a game changer for me. Danny and BetterHelp helped me so much in a short amount of time, and they didn't dismiss me or treat me as less important just because of my adverse financial situation. Because of Danny, I found a local EMDR therapist that I can see, and it has been so helpful. Thank you so much."
The process of looking for a therapist and juggling insurance can be complicated with the many factors involved. We hope that this article has given you the tools to reach out to your insurance provider. If you find that your insurance does not pay for therapy, or there is a deductible that's too high, try taking the first step with BetterHelp. You can cancel at any time, no hassle, no questions asked.
Frequently Asked Questions - The Mental Health Parity Act of 1996 -
MHPA - Mental Health Parity Act - Mental Health Parity and Addiction Equity Act (MHPAEA - Applies to employers with 50 or more employees, Large group health plans)
How much does therapy cost with insurance?
The national average cost of therapy in the United States starts at around $65.00 per hour and can go up to as much as $200.00 an hour (or more) depending on your location and other factors. Health insurance plans who cover services for mental health can help reduce your therapy cost. Since the Mental Health Parity Law took effect, health insurance companies are required to provide equally affordable options for physical health, mental health and addiction.
Do insurance companies cover therapy?
The Mental Health Parity law requires mental health parity and addiction equity for large insurance providers and companies with more than 50 employees. This means that large health insurance companies who offer medical coverage are required to offer equivalent cost options for medical care, mental health visits, and substance use or addiction. Call your insurance company to see what options are available and to find a provider who accepts your insurance.
How much does it cost to see a therapist?
It can cost as little as a few dollars to over a few hundred dollars an hour to see a therapist. This cost is dependent on several factors. People whose insurance covers mental health treatment are only required to pay the reasonable and customary copay to see a therapist. The national average cost of therapy in the US is between $65.00 and up to $200.00 an hour. Low-cost online therapy options can start as low as $40.00 per week for unlimited messaging therapy.
Does Blue Shield cover therapy?
Yes. Some Blue Cross and Blue Shield employers and insurance providers offer mental health benefits. Blue Shield is one of the therapy providers whose plan covers in-office therapy and online therapy treatments. Blue Cross Blue Shield is a major employer whose insurance covers mental health.
How much is therapy out of pocket?
The cost of out-of-pocket therapy can vary depending on your circumstances. For example if you belong to a large group insurance plan you'll have the benefit of therapy services covered under the Mental Health Parity and Addiction Equity Act. This act provides equal benefits for medical health, mental health, and substance use or addiction. People who use health insurance to cover their therapy costs pay the reasonable and customary copayment set for their area. Low-cost and sliding-fee scale options are available for people with lower incomes or no ability to pay for therapy costs out-of-pocket.
How much is a psychiatrist without insurance?
If you don't have mental health benefits, or behavioral health insurance covering mental health you're looking at paying the national average costs for therapy out-of-pocket. This cost ranges between $65.00 per hour to over $200.00 an hour in some cases. The benefit of having a health plan that covers your visits to a mental health provider (and a therapist who can accept your insurance) is that your health plan covers the majority of your therapy costs.
Do most insurance plans cover mental health?
Not all insurance plans cover visits to a mental health provider. This is true in the case of small insurance plans and others who are exempt from the Parity law. The Mental Health Parity and Addiction law requires that large health insurance providers with more than fifty employees are required to provide equal access to medical and mental health benefits. A recent update to the law requires that your insurance cover mental health, substance use, and addiction at the same rate of affordability as your medical health insurance program. The Federal Parity law applies to large insurance plans and large employers who have 50 or more employees (who offer mental health benefits). Large insurance plans run by state employers and agencies cover teachers, firefighters, and police for mental health care services.
Can health insurance refuse to pay?
If your health insurance provider is exempt from the MHPA regulations or if your health plan doesn't offer insurance benefits, yes. It's important to note that not all providers can accept your insurance. Contact your health plan provider to learn if your health insurance covers mental health treatment.
Do you need a doctor referral to see a therapist?
In most cases, no. You don't need to have a referral to see a therapist. People visit licensed therapists for a variety of reasons that don't require a referral. Find out if your insurance covers mental health services under your plan or requires a referral for services.
How long is a therapy session?
Traditional therapy sessions last for an hour per session. Therapy sessions and lengths are becoming more flexible with the advent of online therapy that offers unlimited therapy sessions for always-on therapy. Contact your insurance provider to find out if your insurance covers mental health services online under the Mental Health Parity and Addiction Equity Act.
Can a therapist prescribe medication?
In most cases, no. Prescribing medication falls into the category of medical services. Medical services are provided by a licensed provider like a doctor, nurse practitioner, or psychiatrist who hold an MD or similar degree.
Does insurance cover online therapy?
Some large group insurance companies provide both physical health coverage and cover mental health treatment. A large group provider whose insurance covers mental health treatment can offer coverage for traditional in-office therapy and online therapy treatments. Under the Mental Health Parity Law, large health providers must cover mental health treatment for around the same out-of-pocket costs as medical services. Check with your provider directly to find out if they cover mental health treatment online.
What does out of network mean?
Out-of-network means that you've chosen to get medical services or behavioral health services from a provider that is not listed directly with your insurance network. The cost for using an out-of-network provider are often higher. When you make a claim to your insurance using an out-of-network provider, they may pay your claim reimburse you at the out-of-network rate. Some insurance don't cover out-of-network services. Some out-of-network fees can be reimbursed with a request to your insurance company for reimbursement.
Do you have to pay for Counselling?
The answer to this question is maybe. Some counseling services are free while other therapeutic counseling services require payment. There are several factors that determine if you have to pay for counseling. Under the Mental Health Parity Law, if you work for a large employer that provides medical care insurance, the law requires that they offer insurance comparable to physical health insurance. State-based programs for insurance cover mental health care services in many cases. You can find the number for your provider using the health insurance exchange or on the back of your insurance card.
How do you get low cost mental health care?
There are a few options for finding low cost mental health care.
2. Online therapy offers low-cost options that are less expensive than the national average that can range from $65.00 to $200.00 per hour.
Contact your insurance provider directly to find out if your insurance falls into the parity requirements set forth by the Mental Health Parity and Addiction Equity Act.
Does Blue Cross Blue Shield cover mental health?
Yes, Blue Cross Blue Shield is one of the large group insurance providers (and employers) required to provide coverage under the Mental Health Parity and Addiction Equity Act. Parity requirements state that large employers insurance cover mental health care and physical health care services equally. Check with your provider to see if they are governed under the Mental Health Parity and Addiction Equity Act.
What does Medicaid cover for mental health?
Medicaid is a state-based insurance plan that cover mental health services under the Mental Health Parity and Addiction Equity Act. Under the act, Medicaid is required to cover mental health care services that are comparable in quality and cost to physical health care services.
What can you do if your health insurance company won't pay?
The Federal Parity law applies to large employers and large group insurance plans. In some cases employers are exempt and aren't required to provide contact your insurance provider to find out if the Federal Parity law applies and if your plan covers mental health treatments under the Mental Health Parity and Addiction Equity Act.