Does Health Insurance Cover Therapy? Your Go-To Guide

does health insurance cover therapy

does health insurance cover therapyIf you’ve been experiencing some life challenges, you may have considered therapy. But you may be concerned about your healthcare insurance benefits. Does health insurance cover therapy, and what other mental health services are covered?

Therapy can be expensive but if you need the care, then it’s worth checking to see if your health insurance provider offers policies to help you. There may be a chance your service provider offers some type of coverage for you.

There is a huge demand for mental healthcare so some insurers provide mental health services. In today’s article, I’ll be giving you information on common insurance coverages for therapy and how to find out if your insurer offers these benefits.

We recommend you to check the Health Insurance companies below.

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Common Insurance Coverage For Therapy

Some companies offer healthcare benefits to their employees. But the company must have 50 or more employers for a health insurer to provide coverage for the company. If you have healthcare insurance through your company, it may cover therapy costs.

Even though some people have healthcare benefits through the company, they may still choose to pay for the therapy out of their own pocket. The reason is because some insurers will want a full mental health diagnosis before paying for claims. Most people aren’t comfortable giving this personal information to an insurer.

ACA Marketplace Plans

ACA (Affordable Care Act) marketplace policies must cover substance abuse disorders and mental health services, as well as eight other essential health problems. All health insurance plans sold through the marketplace must cover these benefits.

Additionally, the Affordable Care Act has made it illegal for health insurance companies to charge you more or deny your claim due to prior mental health issues. It’s illegal for health insurers to put lifetime or yearly dollar limits on policies that cover mental healthcare. These plans must cover the following:

  • Counseling
  • Behavioral therapy
  • Substance abuse
  • Impatient services
  • Psychotherapy

Not all ACA health insurance is the same, so contact the insurer directly to see what it covers according to your needs and what it will cost you.

Children’s Health Insurance Program

Children’s Health Insurance Program or CHIP provides federal funds to states. This is so the states can provide affordable health insurance to low-income households with children who are ineligible for Medicaid. This program covers the following:

  • Social work services
  • Substance abuse disorder and treatment
  • Therapy
  • Medication management
  • Counseling

Medicare

Medicare covers substance abuse and inpatient behavioral health services. However, if you go to hospital you may have to pay for coinsurance. This is the percentage of the costs you pay after you’ve paid your deductible. Or you’ll have a deductible per period benefit.

Part B covers outpatient mental health services and depression screening. You may have to pay money out of your own pocket for therapy including the Part B deductibles and coinsurance.

Medicaid

All Medicaid insurers must cover essential health benefits, which include substance abuse and mental health. Your policy may be different depending on what state you live in, but Medicaid offers benefits according to the Mental Health Parity and Addiction Equity Act.

How To Find Out If Your Insurance Covers Therapy

Check Your Insurance Provider’s Website

One of the best ways to check if your health insurance offers mental healthcare services is to check the details on the company’s website. Check the insurance policy you’re on to see what it covers.

If your plan does cover therapy, there may be a list of practitioners that’s in your policy’s network. You can also email or phone your insurer for a list to be sent to you.

Call The Help Care Center

If you can’t wait for a reply via email and you’re not finding the information you need online, you can call your insurance provider’s help care center. There should be a toll-free number you can find online.

Speak to your insurer to find out what therapy treatments are covered and if you have to pay any costs out of your own pocket.

Ask Your Therapist If They Accept Your Policy

Before visiting a therapist, call the office to find out what insurance they accept. If you want to save on out-of-pocket costs, you may have to phone several therapists to find one that works under your insurance policy.

What To Know About Mental Health Services

You will be entitled to mental health services as soon as you sign up for your health insurance plan. However, there are certain aspects that can affect mental health coverage. In some cases, you may have to pay a specific dollar amount on medical services before the plan starts covering you for therapy.

Furthermore, you may have to pay an out-of-pocket deductible before coverage for therapy can start. Other services may want pre-authorization before you can start to benefit from their services.

Before selecting a health insurance provider, make sure you know all the costs and deductibles involved for all types of mental and healthcare services. Treatments that are covered in mental health service plans include the following:

  • Co-existing addiction
  • Depression
  • Psychiatric emergency services
  • Psychotherapy
  • Outpatient services
  • Online therapy 
  • Medical detoxes and medication
  • Rehab stays
  • Clinical psychology visits

What About Couples Counseling?

Couples counseling is an excellent way to reconnect with your partner. But if you’re planning on using your health insurance for couples counseling, you or your partner will need to go for a mental health disorder diagnosis.

However, some people may be apprehensive about getting an evaluation on their mental health because it can remain on your permanent record indefinitely.

What To Do If Your Insurance Doesn’t Cover Therapy

Some health insurance providers don’t cover therapy at all. But if you’re desperate to talk to a professional and you don’t have the funds to pay for it, this can increase your stress levels. This is where you can use network providers.

A network provider is a company that accepts health insurance coverage as a form of payment. The provider will be inside your health insurance’s network. But when you select an out-of-network provider, your healthcare insurance may have limits to what it can cover.

If you have out-of-network benefits, you can see a therapist and get reimbursed for the money you’ve spent. Using out-of-network insurance means you’ll have to pay 60% of your own money towards the therapy before your insurance provider will pay the remainder of the amount.

People choose to use out-of-network insurance to see therapists because it’s difficult to find an insurer that offers therapy plans.

FAQs

Is Seeing A Therapist Covered By Insurance?

Most health insurance companies provide some level of mental health coverage. Therapist visits and emergency mental healthcare are covered by some insurers.

So, when you’re looking for a health insurance provider, make sure the company provides mental healthcare. This is so you don’t have to pay out-of-pocket costs for your therapy sessions.

How Much Does Therapy Cost With Insurance?

You can expect to pay between $60 to $120 per session. However, you may have to pay more than $200 per hour depending on the hours booked and if it’s covered by your healthcare insurance.

How Do I Know If My Health Insurance Covers Therapy?

You can either phone or check your health insurance plan online. When visiting the health insurer’s website, you can read up on the benefits your plan provides. This includes information on mental health policies.

How Can I Get My Insurance To Pay For Therapy?

Call your mental healthcare practitioner to ask if they accept your health insurance and what the terms and conditions for payments are. Find out if the therapist will bill your insurer directly or if you’ll have to pay money towards the fee.

You may have to pay the full amount and then get your health insurance to reimburse you for the amount you paid.

Final Thoughts

If you know you’re going to need insurance for mental healthcare benefits, then it’s important to choose a provider that offers this benefit. On the other hand, if you’ve recently opted for counseling and you already have a health insurer, phone them to find out what mental health benefits they offer.

You may find that your insurer doesn’t cover mental healthcare. If that’s the case, then you may want to shop around for another service provider that will give you the benefit of therapy cover. There may be an instance where your company provides healthcare benefits, which is excellent, because most corporate healthcare policies offer mental health services.

Have you ever used your health insurance for therapy sessions? Was the claims process easy or difficult? If you could recommend a health insurer, which one would it be? Let us know your thoughts in the comments section below.