Is Therapy Covered By Insurance Or Do I Have To Pay?

By Toni Hoy

Updated June 17, 2019

insurance covers therapy

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One of the first things people think about when they are trying to make a decision about attending therapy is how much it costs and how they will pay for it. Insurance laws and programs have changed drastically since the Affordable Health Care Act came into existence. You may be asking yourself, "Is therapy covered by insurance?" You may also be wondering if there are other ways to pay for it rather than filing a claim with your health insurance provider.

Does Insurance Cover Therapy and Should I Use It as a Source of Funding?

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 them to pay for the total cost of therapy, if it's covered at all. They may cover a portion of the payments. They may also have a limit on the number of sessions that they will pay for or a total cap on the amount that they will pay. You may also need to pay a co-pay or satisfy a deductible before the insurance company pays their portion.

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Many health insurance companies require that you first schedule an appointment with your primary care provider before they will approve costs for sub-specialties, which can include therapy. You'll want to take into consideration that many counseling sessions aren't terribly expensive. It may be more cost-effective to just pay out-of-pocket. You'll find that the costs at BetterHelp.com are quite reasonable.

Common Insurance Coverage Concerns

It's a relief when you have health insurance. You can go to the doctor if and when you need to see a medical provider. And now, you're thinking about all aspects of your health, including mental wellness. You may be wondering, does insurance cover therapy? There are a lot of companies that include mental health coverage. Many insurance plans do cover therapy. If you're lucky to have insurance coverage for mental health, you have many options for treatment. You might find a therapist or counselor in your area who you'd like to see for treatment. However, you need to check with your insurance to see if this provider is in the network. Before seeing a therapist, it's important to see if the provider takes your health insurance. One way to find out is to call your insurance provider and ask. If you're wondering about the coverage you have, you can inquire on the phone.

Here are some questions to ask your health insurance company when you have them on the phone:

● Does insurance cover therapy?

● Is the therapist I want to see in the network?

● Which therapists do take my insurance?

● Where can I find a list of therapists who accept my insurance?

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 provides. Knowing what your insurance covers can help you determine the course of your mental health treatment. You want to start seeing a therapist with realistic expectations. Find out how many therapy sessions your insurance covers per year. Many insurance plans will have a cap on the number of therapy meetings you can have in a year. You might want to see your therapist once a week, and you want to make sure you have enough sessions to do that. It's crucial to have the information up front before you see a therapist. Remember that therapy is a relationship that you're developing. When you see a therapist, you know that you are guaranteed to be able to meet with them once a week. That's comforting because you have a reasonable expectation for your treatment plan.

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● How much does therapy cost out of pocket?

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Out-of-Network Providers

Sometimes you'll find a great therapist, and ask them if they accept your health insurance. They'll 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. That might sound tempting when you hear the word "reimbursed," because you think that you get your money back. However, it also means that you have to pay a significant amount of money to your therapist upfront before you get any money back. 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.

Therapy: Ask For Referrals For Therapists

When you're looking for a therapist, it's good to find one who has been recommended to you. There are times when you wish you could see a particular therapist, but they don't take your insurance. However, they might know another provider who does take your insurance plan. Don't be afraid to ask them if they know anyone who accepts your insurance coverage. Sometimes, they might have to write down your information and get back to you, but it's a great way to get a competent therapist. They can look through the list of names who are covered under your insurance and recommend anyone they recognize or know personally. When a therapist recommends another mental health professional, it's a good sign.

Health Insurance Deductibles

Finding out what your health insurance covers for mental health treatment can be overwhelming. When you figure out that your insurance covers behavioral health you're relieved. After you investigate and find out that your insurance covers therapy, there's still more work to do. Naturally, you're thrilled, and you can't wait to see a therapist. But, then you realize that your insurance has a deductible of $2000. It's as if you're smoothly driving down the road and all of a sudden you need to hit the breaks on your car. Even though your therapist takes your insurance plan, you have to pay for each session until you reason $2000 before the insurance company covers the cost of therapy. You were excited that you had insurance that offered therapy coverage, and now your plans are derailed. You've got to come up with the money to see a therapist for a long time before the company starts kicking in and helping you out with the cost of mental health treatment. You might not even reach your deductible before the end of the year! And then you start paying out of pocket for a therapist.

Sliding Scale

It's no wonder that some people are finding therapists who work on a sliding scale as an alternative to those who accept their insurance plan. 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 your pocket until you reach your high deductible. Some people find a therapist they like who doesn't take their insurance, but who will work with them and see them on a sliding scale. They might charge a lower fee than another psychologist who has a private practice, and you bypass the deductible problem. Another option is to find a low-cost clinic. Some places 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. These students have to see clients as a part of their program, and you can see them 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.This information may have led you to understand that it doesn't make sense for you to request that your health insurance provider cover your therapy sessions; however, that is a personal decision and each individual should do what works best for their own financial stability.

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.This information may have led you to understand that it doesn't make sense for you to request that your health insurance provider cover your therapy sessions; however, that is a personal decision and each individual should do what works best for their own financial stability.

Is Therapy Covered by Insurance Under the Parity Laws?

The parity laws have some effect on the benefits for therapy, but the laws don't require insurance companies to cover therapy in all situations. The parity laws require health insurance providers to cover mental health conditions on equal terms as physical health. This means they can bill you for co-pays and deductibles on equal terms with other illnesses.

Insurance Coverage: Is There a Downside to Claiming Therapy Costs Using My Health Insurance?

There are some negative reasons for using health insurance to pay for therapy. Health insurance companies often need to have a diagnosis before they will pay your claims. This gives them the opportunity to ask your health provider any questions about your health and well-being. Anything that they learn goes into your health file, and you have little or no control over who can access it from there.

therapy insurance coverage

If You Don't Have Insurance - No Problem, We're Here To Help You
Click Here To Get Matched With A Licensed Therapist Today

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The reasons that led you to counseling may not be something that you want stored in your personal health file. You may not want to risk letting information out that could cause new problems in your employment or other personal matters.

Cost should never be a reason that you avoid getting help that you need. Claiming it under your health insurance is a personal decision. It's wise to learn all the pros and cons before making a final decision on how to pay for therapy sessions.

If you have any questions, please contact us at contact@betterhelp.com or check us out online at Facebook, Twitter, Instagram, Google+, LinkedIn, Pinterest & Tumblr. Follow APA Google+ for more information on promoting health, education, and human welfare.

If you need a crisis hotline, please see below:

RAINN (Rape, Abuse, and Incest National Network) - 1-800-656-4673

The National Suicide Prevention Lifeline - 1-800-273-8255

National Domestic Violence Hotline - 1-800-799-7233

NAMI Helpline (National Alliance on Mental Illness) - 1-800-950-6264


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