How to Find Out if Health Insurance Covers Therapy

Do you have health insurance? If so, does it cover therapy? While this might seem like an obvious question, most people overlook it until it’s too late—and by then, they’ve already paid thousands of dollars out of pocket for their services.

So, what steps can you take to find out whether your coverage includes help from a qualified therapist?

First, you should check your plan documents or ask your provider directly to see if the plan covers mental health services in general or counseling services specifically.

Is your health insurance plan an HMO?

The big question is whether your health insurance is a managed care plan, which means it’s an HMO. In these types of plans, your therapist will most likely be out-of-network.

Some HMO plans include therapy in their network, but these are harder to find. If you have a managed care plan and want a counselor who accepts your insurance, call around or search online for one in your area who has a health maintenance organization (HMO) contract with your provider.

You can also ask if they work with any specific managed care organizations.

What types of therapy are covered by your plan?

You want to make sure your health insurance covers therapy before you decide which type of care provider is right for you. Some therapists will participate in only one or two insurance companies’ networks, while others take many different plans. Knowing how your health plan works is a key first step in getting help.

So, check with your insurance company: How do they prefer that providers submit claims? Are certain forms required? What codes should be used when billing them? Are mental health services covered at all? If so, how much does coverage typically pay and what kind of therapy is usually covered (for example, are family counseling sessions included in my policy)?

Many questions need answers before you can make an informed decision about your choice of therapist. Be sure to ask as many questions as you need to get clarity on any aspect of what’s covered and what isn’t.

If there are no limits, is your therapist part of the network?

If you’re wondering whether your health insurance covers therapy, it’s important to find out exactly what it covers. This can mean reading through a benefits booklet or calling up customer service.

If there are no limits on what kind of mental health treatment is covered, make sure your therapist is part of your insurance network before booking an appointment. If you go out of network and don’t get reimbursed, that money is coming straight out of your pocket!

You should also ask about how much out-of-pocket costs will be if you receive care outside of regular sessions. Some therapists offer monthly packages for those with frequent needs, but generally speaking, many plans will cover unlimited sessions in a year—or more—before any fees kick in.

These types of fees also vary between different states so make sure to look into them if you reside in one with major restrictions when it comes to paying for therapy sessions.

Most therapists today charge per session, not by hour (unless they’re working under managed care), so these fees won’t affect lengthier treatments like PTSD and couple’s counseling.

Can you get reimbursed for sessions not paid out-of-pocket?

Unfortunately, even if you have health insurance that covers therapy, there is no guarantee that you will get reimbursed. Many therapists have had patients who have found out they weren’t eligible for reimbursement after they’ve paid hundreds of dollars out-of-pocket and completed their session.

The only way to know for sure whether or not your sessions are covered is to ask your therapist and your health insurance company. Additionally, it’s a good idea to call before scheduling appointments.

Are you seeing a licensed or accredited provider?

Many health insurance providers offer some coverage for mental health services, but it’s often limited and might not include a licensed therapist. Check with your plan’s provider directory or call its customer service number to see what your network offers.

If you use an online search engine (like Google), make sure you only look at websites that are associated with your plan—don’t assume other therapists are in-network.

Also, some therapists may have their private practices and work outside of any larger system; always ask before you book an appointment whether they accept your insurance. In addition, most group therapy sessions won’t be covered by insurance; check with your therapist about her policies.

Can your therapist accept insurance as payment in full?

If not, you may be able to apply for an out-of-network benefit. Contact your insurance provider and ask whether they provide a discount or a separate payment tier for out-of-network providers. If so, call your therapist’s office and make sure they accept these forms of payment.

If they don’t, consider looking for another therapist in your network who does. It may take time, but searching for available therapists is always worth it when finding one that fits with you and your needs.

Furthermore, some therapy types are covered under different health insurance plans; some are eligible for payment as part of work benefits; others through private pay with flexible schedules, etc.

Make sure to look into all options before making any decisions! Asking around can help too – friends, family members, social media groups (like our very own Community!) are all helpful resources that can lead you in the right direction.

However frustrating it might seem at first—take heart: it doesn’t take much effort to find a great fit when healthcare coverage is involved!

Will it cover psychiatric drugs prescribed by your doctor?

It depends on which insurance plan you have and whether it covers psychiatric drugs. For example, Medicare Part D provides coverage for some psychiatric medications but only if they’re taken at a hospital facility or outpatient treatment center.

Most health insurance plans will pay for psychotherapy sessions with a psychologist or social worker but not for psychiatric drug prescriptions.

Medication is almost always cheaper than talk therapy, but sometimes psych meds are cheaper to cover through health insurance than through your local psychiatrist.

Do you need prior authorization for treatment?

Each health insurance plan is different, and some plans require prior authorization for certain treatments. Prior authorization means you have to call your insurer and get permission before your treatment can begin.

It’s a common reason people are declined coverage. If you think a specific therapy might be covered by your health insurance, but you’re not sure whether or not it requires prior authorization, ask your doctor or therapist what they recommend so that you aren’t surprised with an unexpected bill.

And don’t forget: some services like family counseling aren’t covered at all by many insurance plans, so make sure to check into that as well!