There are numerous benefits that can come with therapy. Getting therapy can improve symptoms of mental health issues like anxiety and depression. Working with a counselor or therapist can also improve your overall quality of life, your relationships, and even your physical health.
Some people are nervous about the idea of starting therapy, though, for various reasons. One such reason is the cost.
If you use a resource like Mental Health Match, you can find licensed therapists in your area who are in-network with your insurance. With that in mind, the following is also a guide to what to know about insurance coverage for mental health care and therapy.
The Meaning of In-Network
When you’re searching for therapists who will meet your unique needs, you’ll often see the terms in-network or out-of-network.
These are important when it comes to paying for the cost of therapy.
In-network means that a care provider contracts with your insurance company to accept a negotiated rate. You will pay less than you would with an in-network provider because out-of-network providers haven’t negotiated these discounted rates.
You have to determine whether or not a therapist or mental health provider is in-network with your insurance plan, so be sure to figure this out before making an appointment.
Also, the idea of accepting your insurance and being in-network doesn’t have to necessarily be the same. A provider might accept several types of insurance, but that doesn’t automatically mean they’re an in-network provider for your plan with one of those carriers.
There are three insurance plans that use in-network providers.
The first is a preferred provider organization or PPO. These have preferred providers selected by the insurance company for you to use.
Then, there are health maintenance organizations or HMOs, which may limit your provider network more, and you’ll probably also have to choose a primary care physician for referrals.
Another type of insurance plan that uses in-network providers is the point of service or POS, which is somewhat like a hybrid between an HMO and PPO.
Insurance Coverage for Therapy
One of the biggest barriers to people receiving mental health care is that they’re afraid about the cost of treatment. Mental health care can be expensive, but you might be more able to afford it than you initially thought. Your insurance may cover some or all of it. Even if you don’t have insurance, there might be options available to you.
You, in simple terms, can see a therapist through your insurance, but it gets more complex than that.
One factor that plays a big role in whether or not your therapy will be covered by insurance is if you have a specific mental health diagnosis. A mental health diagnosis can include depression, anxiety, phobias, acute stress, and other conditions.
There are laws in place to protect people who have a diagnosed mental health condition to make sure they’re able to get the mental health care they need.
Under the Affordable Care Act passed in 2010, any plan purchased through the Health Insurance Marketplace is required to provide mental health care coverage and coverage for substance use disorders.
A Health Insurance Marketplace plan is required to offer mental and behavioral inpatient health care services, counseling and psychotherapy, coverage for pre-existing coverage, and parity protection. Parity protections mean that things like co-pays and deductibles are close to or the same as medical and surgical benefits offered.
If someone has Medicaid, these plans are state-run, and they are required to cover anything that’s characterized as an essential health benefit, including mental health services.
Blue Cross Blue Shield is one of the nation’s largest insurance providers, and most plans cover therapy. The same is true of Kaiser Permanente.
Types of Therapy That May Be Covered
Even if your insurance plan technically covers therapy, it may be limited in the particular services with coverage.
Mental health treatments we most frequently see covered by insurance include:
- Co-occurring medical conditions and behavioral health conditions like co-occurring addiction and depression
- Emergency psychiatric care
- Talk therapy, such as cognitive-behavioral therapy
- Online therapy and telemedicine
- Outpatient therapy
- Substance abuse treatment
- Drug and alcohol detox services
Verifying Coverage
If you’d like to learn whether your specific insurance will cover therapy and mental health care, there are some steps you can take.
First, start by registering your online account with your health insurance provider if you haven’t already done so. Most insurance plans will have a lot of information about coverage and costs.
You need to make sure that you’re looking at the information for your particular plan.
You can also find out typically through the online portal whether you should be looking for a provider or therapist in your plan’s network or if you might be responsible for additional fees if you’re out of network.
Another option is to directly call your insurance provider. They’ll be able to answer questions you have about coverage as it pertains to your plan. Ask about out-of-pocket costs, and also learn more about what your limitations on services might be.
If you’ve found a therapist you’d like to work with, you can ask them for the diagnostic code or codes they’d use when filing your claim. If you can get the codes and then provide them to your insurance company ahead of time, they’ll be able to let you know how much you might be responsible for out of pocket.
You can’t be penalized legally for having a previous diagnosis or pre-existing condition for a mental illness, so you should be entitled to receive covered mental health services from the start of your plan.
The things that can affect when insurance coverage kicks in include prior authorization, which is required for some services, or after you meet your deductible. Some plans might require that you meet a spending minimum before coverage for therapy begins. Finally, if you’re going to have to pay for therapy out of pocket, you can also talk to a provider about any discounts or sliding fee scales they use based on income and financial need.
