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In this blog, we will explore some of the options you have when it comes to paying for therapy through medical health insurance through your employer, and other types of insurance available. The number one question people typically have when faced with a mental health dilemma, while considering employing a therapist, is: Does health insurance cover a therapist?
Other questions we will cover for you include: What is the best insurance for mental health, and should all insurance plans cover therapy? By the end of this blog, you will know what to expect when it comes time to address your mental health with a professional.
How Insurance Typically Works for Mental Health Services
In-Network Vs. Out-of-Network Providers
As with all insurance types, the cost of in-network providers versus out-of-network providers is different. The following table will summarize some of the differences:
| In-Network Providers | Out-of-Network Providers |
| Negotiated rates with providers who provide mental health services from insurance companies with resources are typically a lot lower. | You typically pay higher costs associated with out-of-network services. The out-of-pocket money can be substantially higher |
| Lower costs in the form of co-pays and coinsurance, especially when deductibles are met. | You may have to pay a percentage of the bill (coinsurance) instead of just the co-pay. |
| Providers have a contract with the insurance companies, ensuring lower costs for the insured. | There is no contract with providers and insurance companies, so there is no guarantee of coverage of any kind. |
| You may need to meet a deductible or gain a referral from a primary care physician in order for services to be covered. | There may be some reimbursement options for services paid when using out-of-network providers. |
Types of Therapy Often Covered by Insurance
Whether you are covered under insurance from your company or a purchase policy through the Marketplace, there are specific laws that are adhered to by insurance companies. To answer the question of, “does health insurance cover therapy?” or in general, “does insurance cover therapy?” It helps to know that if you purchase a policy through the Marketplace, by law, it is required that those policies cover mental health and are treated equally with physical health.
By law, if provided insurance through the Marketplace, your mental health benefits are guaranteed to be there in some form due to the Mental Health Parity Act of 2008 (MHPAEA). Also, the Affordable Care Act (ACA) of 2010 was established to reduce the cost of health insurance for anyone who wanted it and needed it based on their income level. In addition, if you have coinsurance through your employer, they do not have to participate in the ACA guidelines, but typically are more well-suited and have more resources to negotiate with providers for lower rates for their services.
Below are some bullet points showing what services are typically covered by insurance companies:
- Individual therapy
- Group therapy
- Family therapy
- Outpatient therapy
- Inpatient therapy
- Cognitive Behavioral Therapy (CBT)
- Dialectical Behavioral Therapy (DBT)
- Eye Movement Desensitization and Reprocessing (EMDR)
- Acceptance and Commitment Therapy (ACT)
- Substance Abuse Treatment
- Psychotherapy
- Partial Hospitalization due to a mental diagnosis and reduction of capabilities
What Affects Whether Therapy Is Covered or Not?
In the following bullet points, I will cover some of the reasons why therapy is covered and not covered:
- Plan type – Health Maintenance Organizations (HMOs) will sometimes require a referral from a primary care provider to approve funds for treatment. Preferred Provider Organizations (PPOs) may have more flexibility, but at increased costs.
- Coverage limits and some restrictions – Certain types of therapies may not be covered for whatever reason they deem necessary for their coverage allowances. Also, they can place limits on the number of sessions with a mental health provider you get to use within a year.
- Out-of-pocket costs – These can vary widely between plans that are offered by different insurance providers.
- In-network versus out-of-network – The cost difference between these two networks can vary widely. Using in-network providers will inevitably be cheaper.
- Deductible – Some insurance companies may require that you have met your deductible for the year before allowing coverage for mental health therapy services.
- Prior authorization – Some insurance companies may want you to authorize the therapy with them before they approve it.
- Medical necessity – One requirement insurance companies may want you to have is a diagnosis from a qualified professional before they will allow coverage. Also, general life coaching therapies and counseling services may be off the table for coverage as insurance companies may not see these as necessary medical needs.
The Best Insurance Options for Mental Health Coverage
All Marketplace health insurance plans are required by law to provide mental health and substance abuse therapy coverage. In addition to this, the priority of the mental health services offered is deemed just as important as physical health, by law. And according to Forbes.com, the best mental health coverage from an insurance provider comes from Blue Cross Blue Shield and UnitedHealthcare, based on their analysis.
These companies were ranked on a spectrum of services that are offered to choose from, such as telehealth services, coverages, applications, and online services provided. These companies also have low complaint levels from insured individuals who take advantage of the services offered.
The best health insurance providers regularly receive high ratings from both the federal government for their implementation of the Affordable Care Act (ACA) of their individual Marketplace plans, and high ratings from the National Committee for Quality Assurance, which exists to improve the quality of healthcare.
What If Your Insurance Doesn’t Cover Therapy?
Alternative Resources and Low-Cost Options
There are alternative options for affordable care. For instance, some therapists will offer a sliding scale therapy cost that will save you money for each session that you attend. You can always appeal the coverage denial of your request for mental health coverage through official channels set up by the insurance company.
You can research university clinics that usually offer reduced costs for mental therapy, seek out non-profit organizations that will provide free therapy sessions and low-cost sessions for those in need. Be on the lookout for community-based local support groups that may offer free or low-cost therapy and counseling sessions.
Sliding Scale and Community-Based Care
Some therapists believe that what they do makes an impact in their community and will offer a sliding-scale pay structure for low-income clients. They will base this on the financial status of their clients within a tier system of income and the size of the client’s family that is being supported.
Community-based care is designed to keep the individual within the community without having to travel long distances for care, connecting the individual to care options within their local community. The community-based care system takes the facility-provided services off the table and encourages a continuum of care within the community, from screenings to assessment to treatment and case management. Community care services are typically centered around school settings, workplaces, housing, and legal services.
Have Questions About Coverage? Lonestar Mental Health Can Help
At Lonestar Mental Health, we can help you understand and manage your anxiety and help you understand your insurance coverage. We are a patient-centered practice tailored for your comfort and peace of mind. We offer expert, personalized care tailored to your needs in a peaceful environment with comprehensive care in mind, made up of a team of experts. You can contact us at any time, and we will respond to you promptly as our team is online 24/7 to assist you when you may need it most.
FAQs
Does insurance pay for therapy?
Should all insurance plans cover therapy? While insurance may not pay 100% of the cost associated with therapy from a licensed professional, coinsurance and copays make it a lot cheaper to see a professional without the total up-front cost associated with therapy for individuals without insurance.
How much does therapy cost with insurance?
Therapy will range in cost from one insurance company to another, and if coverage is available, you may need to meet a deductible to qualify for the insurance coverage. One thing for sure is that covered therapy will be a lot cheaper with coinsurance, copays, and deductibles. Insurance can reduce costs by up to 60-75%, with typical sessions costing only around $20 US dollars. Without insurance, expect to pay $60 US dollars or more per session.
What mental health services are covered?
A range of mental health services is offered for coverage from different providers and not all providers offer the same coverage for the same prices. Some insurance companies may offer no service coverage for a particular type of therapy, while others will.
Can I get free therapy with insurance?
While insurance companies cover mental health, this can lead to free services, yes.
What to do if my insurance doesn’t cover therapy?
There are several paths to take if the insurance company does not cover your request for therapy services. You can appeal the coverage denial through official channels set up by the insurance provider. You can also seek alternative paths, such as free counseling services through community-based groups and churches. Other options would include low-cost services offered directly from therapists called sliding-scale payments, which significantly reduce the cost of therapy sessions.
