Will My Insurance Help Pay for Therapy?
Easy, affordable access to mental healthcare access should be a given, for anyone who needs it. And yet for many people, the cost of accessing therapy can feel out of reach.
If you’re starting the search for a therapist, you might be wondering:
What are the options available to people to help make therapy more affordable?
Will insurance help cover the cost of my therapy?
The short answer: It depends.
How much — and whether — your insurance will reimburse you for the cost of therapy depends on the type of insurance you have, the deductible associated with your plan, the type of diagnosis you will be receiving treatment for, and, honestly, the whims of the insurance company. I’ll explain.
What kind of insurance do you have?
If you have an HMO insurance plan, your insurance will only pay for you to see someone “in-network.” I, for instance, am not in-network with any insurance company, but if you want to use your HMO insurance for therapy, you can contact your insurance company (or check their website) for a list of the in-network providers they contract with directly.
If you have PPO insurance, you can select any provider you wish, but getting reimbursed for therapy usually means paying the fee for sessions out of pocket and then submitting a “superbill” (an official receipt for services which includes a mental health diagnosis) to your insurance afterward, and receiving a check in the mail after the fact.
What’s Your Deductible?
Whether you’re looking to see a therapist in-network or out of network, your particular insurance plan may have a set “deductible,” i.e., an out of pocket amount that you must pay for services in a given calendar year before insurance will chip in anything. This can be a huge variable in determining whether you’ll see any insurance reimbursement for the cost of therapy, and how much.
To find out what your deductible is, you can call the customer service number on the back of your insurance card, look at the plan details provided by your employer, or (my personal favorite method), use an outstanding new app called Reimbursify to check your benefits (and easily submit out-of-network claims, too). I love this service and I use it to help prospective clients check their coverage, as well.
Not all diagnoses are equal
To reimburse for mental health care, insurance companies require your therapist to specify a mental health diagnosis (or diagnoses) from the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, also known as “the DSM” (currently in is 5th edition, DSM-5).
However, not every condition listed in the DSM may be considered “reimbursable” by insurance. For instance, there is a whole section in the DSM-5 manual which lists various problems of daily life or circumstance that are significant enough to require support but don’t quite fall under the umbrella of mental health disorders (these situational stressors are called “V-codes”). Some insurance companies may not reimburse for treatment if a V-code is the only diagnosis, so you should discuss this with your therapist before starting treatment if being able to get insurance reimbursement is a necessity for being able to work together. Your therapist cannot assign you a diagnosis that you do not actually have just to get insurance reimbursement for you, but they may be able to offer you a sliding scale fee, or refer you to another practitioner or clinic that can work within your budget.
Insurance Companies Make the Rules
When you’re using insurance to help pay for therapy, the amount of possible reimbursement you may receive depends on the rules set by each individual insurance company. Each insurance company sets a “usual, customary, and reasonable (UCR)” amount that they are willing to reimburse for various services. This amount is based on what is typically charged by similar providers who work within the same geographic area.
Depending on what the insurance company has decided they’re willing to pay for different types of diagnoses and service types, you might receive total or only partial reimbursement for the cost of a given session. Insurance companies really don’t like to disclose ahead of time what their established “customary" fee is for a particular service, so often you don’t find out how much reimbursement you’ll receive until you get the first check from them in the mail.
Questions to Ask Your Insurance Company When Checking Your Mental Health Benefit Coverage
If you are going to be checking on your own benefits coverage (rather than having a prospective provider doing it for you), here are some important questions to ask your insurance:
1) Do they reimburse for out-of-network mental health services, or do you need to see a provider within their specific network for services to be covered?
2) Is there a maximum benefit amount you can receive per year? (ex. do they cap you at a certain number of sessions per year?)
3) Do they reimburse for telehealth? Certain states, such as California, have telehealth parity laws that require insurance companies to reimburse for telehealth sessions at the same amount as they would for in-person sessions. Unfortunately, while insurance companies have been covering telehealth services more broadly since the onset of the pandemic, not every state has the these same parity laws which require insurance companies to do so.
4) Does your plan have a deductible you need to meet, and if so, what is that amount? The deductible is a set amount decided by your insurance company that you'd need to pay out of pocket during a particular calendar year for mental health services, before they'd begin to reimburse you a portion of the cost. There may be a separate deductible amount for in-network services versus out-of-network services, so be sure to ask what the amount is for both.
How to Submit Out-of-Network Claims For Therapy to Your Insurance
The process for submitting out-of-network claims varies by insurance company:
Sometimes, your provider can submit the claim directly to insurance on your behalf (this is somewhat uncommon, though, because it usually requires hiring a designated insurance billing person to handle this task).
Some insurance companies make it easy for you to submit out-of-network claims with a few clicks on their website.
Others require that you mail or fax them a paper copy of your superbill for sessions in order to process your claim.
You can get the free Reimbursify app, and sign up for an individual account. If your provider is already set up with Reimbursify, you’ll be able to submit a certain number of claims per year for free (if not, it’ll cost you about $2 per claim to submit your own).
How To Pay for Therapy Without Insurance
If you don’t have insurance coverage, the provider you want is out of network, or you don’t feel comfortable with a mental health diagnosis going onto your medical record*, here are some additional options you can pursue to pay for therapy out of pocket:
Explore paying with funds from an employer-provided health savings account (HSA), medical savings account (MSA), or flexible spending account (FSA). Your employer may also be able to provide a limited number of counseling sessions through a therapist contracted with their Employee Assistance Program (EAP). Ask your employer about whether any of these types of benefits are available to you as part of your benefits package.
Ask your prospective therapist if they have any discounted “sliding scale” spots available, and if so, for what duration of time.
Search online directories that list therapists who accept sliding scale rates or who work within the specific price range that fits your budget (for two great options check out Mental Health Match and Open Path Collective)
For more help in finding a great therapist you click with (in your area, price range, and preferred demographic), check out my resource-packed blog post on How To Find a Good Therapist.
*Note: Your medical record is private information is covered by HIPAA law in the U.S. Your private health information cannot be shared without your consent, with a few legal exceptions. Ordinarily, your mental health diagnosis remains private information unless you choose to disclose it, but to my knowledge, there are a few areas in which life could possibly be impacted by having certain types of mental health diagnoses on your record. These most notably include applying for life insurance or long-term disability insurance, and historically, people have been concerned about the possible impact to their job prospects in fields such as law enforcement, public safety, ministry, aviation, the military, or other types of jobs that could require a psychological evaluation. If you are concerned about the possible impact of a diagnosis, please discuss this with your therapist at the outset of treatment or consider paying out of pocket for your therapy without seeking insurance reimbursement. If you have received a past diagnosis that you feel is incorrect, or your condition has noticeably changed, you should mention this to your new therapist, as well. Your therapist can perform their own assessment and add any new information to your record to reflect why they believe an updated diagnosis is appropriate; however, an old diagnosis cannot legally be deleted from your record.
Therapy Should Be For Everyone
There are so many options that exist today for seeking mental healthcare, as stigma surrounding mental health decreases, and access to mental healthcare improves. Now more than ever, in a world that will be grappling for a long time with the mental health effects of the pandemic, everyone who needs support should have the opportunity to find it. Don’t let fear of the cost stop you from reaching out for the help you need.
For further reading, check out Why People Go To Therapy.
Important disclaimer: Although I am a licensed marriage and family therapist by profession, I am not YOUR therapist. The content on this site is for informational or educational purposes only. Although I strive to provide accurate general information, the information presented here is not intended to be a substitute for professional medical advice, diagnosis, or treatment, and does not constitute medical or other professional advice. Your use of this website does not establish any kind of patient-client relationship with me, and you should consult a healthcare provider in your area if you are seeking medical advice, diagnosis, or treatment. Reliance on any information provided herein is solely at your own risk.