- Many health insurance plans offer coverage for therapy and other forms of mental healthcare. But if you want to use your health plan to pay for therapy, it’s important to understand your benefits and the limits of your coverage.
- Your health plan’s summary of benefits should outline how your plan covers costs associated with therapy. But if you’re having trouble understanding the specifics, use the 800 number on the back of your insurance card to contact your insurer to ask questions.
- Unexpected bills can add up to extra stress. So prior to making an appointment with a therapist, verify any coinsurance or copayments you might be responsible for and confirm that your therapist is in-network with your health plan. If you find a therapist using Path, our team will check your benefits for you and email you an estimate of your costs before your first session.
To put it simply — navigating health insurance can be confusing. And this includes figuring out your coverage for mental health services like therapy.
This holds particularly true if you recently changed your health plan or if you just obtained insurance for the first time. In order to make the most of your mental health benefits you need to know how they work.
So whether you’re looking to meet with a therapist in-person or find online therapy that takes insurance, it’s important to clarify your coverage and the financial obligations associated with your care.
Does insurance cover therapy?
For a long time, health insurance companies treated coverage for mental health and physical concerns differently. Visible health conditions, like a broken arm or heart disease, have historically received higher coverage rates compared to mental health conditions like depression or anxiety. So if you’re confused about whether or not your health insurance plan covers therapy, you’re not alone!
Fortunately, more health plans are beginning to offer mental and behavioral health benefits. However, your insurance may not guarantee coverage for therapy, depending on your policy.
So it’s important to understand how your health plan handles mental healthcare before making an appointment with a therapist. Here’s how to determine your health insurance coverage for mental healthcare:
- Review your plan’s summary of benefits. This is a lengthy document that your insurer provides when you sign up for coverage. They may provide a hard copy or it might be accessible via your online account. It details the ins and outs of your coverage and should describe your mental and behavioral health benefits.
- If you have trouble finding this information, talk to someone who can help. There should be an 800 number on the back of your insurance card that you use to contact your insurer to ask questions. You might also be able to email your insurance company using the contact information listed on their website.
- When you talk to your insurer, let them know that you want to verify your mental health benefits. Ask them about coverage for therapy as well as other forms of inpatient and outpatient treatment. They should be able to specify the number of sessions you’re eligible for per year and how much your plan will pay towards the costs of therapy. Also, be sure to ask about any coinsurance or copays you might need to cover and ask if these payments count toward your annual deductible (more on these terms below!)
Determining the cost of therapy with insurance
Once you’ve reviewed your health plan’s summary of benefits or confirmed your mental healthcare coverage with your insurance company, it’s time to estimate the cost of care.
Having health insurance doesn’t mean you’ll pay nothing out of pocket for therapy. Each health plan is unique and there are many different models for financial reimbursement and coverage.
So to avoid the stress that comes from unexpected bills, be sure you have a clear understanding of the following before making an appointment with a therapist.
This is a fixed charge that you’ll need to pay out of pocket for a therapy session. This fee is on top of what your health insurance plan pays your therapist. Copays can vary widely depending on your benefits, so talk to your insurance provider to verify the amount. Find out whether or not your copay counts toward your deductible (see below) and/or out-of-pocket maximum (see below).
When you have a health plan with a deductible, you are responsible for paying for all of your healthcare expenses before reaching that amount. If your plan doesn’t include a copay for mental healthcare, you will need to pay the full cost of therapy sessions before your insurance begins covering a portion of your therapist’s rate. Sometimes, payments for care only count towards your deductible if you see an in-network therapist (see below).
After you meet your deductible, your health plan may implement a co-insurance agreement. At this time, you’ll pay for a predetermined percentage of covered expenses and your health plan will pay for the rest. Sometimes, coinsurance payments and copays count toward your out-of-pocket maximum (see below).
In Network vs. Out of Network
If your therapist is “in network” with your health plan, the plan and provider have prenegotiated a reduced rate for services. This means that your health plan will cover a portion of the cost of your therapy bill.
But keep in mind that this coverage may only “kick in” once you’ve reached your deductible and you may still be responsible for a copay or coinsurance payment for your sessions. If a therapist is “out of network” they are not able to bill your insurance company for the cost of your care. But some therapists offer sliding scale fees that make it easier to access affordable therapy without insurance.
Many insurance plans place a limit on what an individual or family has to pay out-of-pocket for healthcare during a single year. Once you hit your “out-of-pocket maximum” (typically via your deductible, copay, coinsurance, and/or other medical bills), your insurance company will pay the remaining balance for any covered medical bills you incur that year. Double check with your insurer to determine which of your medical bills will count towards your out-of-pocket maximum.
Once you understand the specifics of your coverage and the costs associated with therapy, it’s time to find a therapist who’s right for you. Your insurance company can provide you with a list of in-network providers.
Prior to making your first appointment, be sure to double-check the date your insurance coverage goes into effect. And keep in mind that if your plan changes in the future your coverage for certain services like therapy might change too.
How Path can help you understand your mental health benefits
The first step in making the most of your health insurance coverage is understanding your benefits. But this isn’t always a straightforward process!
At Path, we believe in simplifying insurance and billing so that you can focus on getting the care you need. Before your first therapy session, we’ll verify your benefits with your insurance provider and email you an estimate of your out-of-pocket costs per session.
You can also use Path to help find a therapist who accepts your insurance, is accepting new patients, and matches any criteria you have (like if you’d prefer to work with a therapist of a certain gender or race, who specializes in a certain diagnosis, or who has availability at certain times of the week.)
Path helps you embark on your mental health journey with an insurance-covered therapist, and you’ll be aware of the cost of your care. See our FAQs for more details.
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