Health insurance can often feel overwhelming, particularly when trying to determine what your plan covers. Even individuals with comprehensive coverage may hesitate to seek therapy without understanding the costs involved.
Does Health Insurance Cover Therapy?
The answer depends on your specific plan. Most health insurance plans in the United States cover mental health services, often treating them like other medical costs. This means therapy sessions could require a co-pay or apply toward your deductible.
To better navigate therapy coverage under your plan, here’s what you need to know:
Understanding Your Insurance Plan
- Co-Pay vs. Deductible:
- Co-Pay Plans: You pay a fixed amount for each session, and your insurance covers the rest.
- Deductible Plans: You cover 100% of costs until you meet the deductible, after which insurance pays a percentage of the expenses.
- Confirm the cost per session with your therapist and check if your insurance has a negotiated in-network rate for discounts.
- Plan Type and Coverage:
- Employer-sponsored plans may limit your choice of insurance companies. If you purchase insurance privately, research plans carefully to ensure they meet your mental health needs.
- Therapy session costs typically range between $65 and $200 in the United States, depending on location, therapist qualifications, and specialization.
- Identifying Your Plan Type:
- Your insurance card or the provider’s website will specify your plan type. For further clarity, contact customer service using the number on your card.
Options When You Can’t Afford Your Deductible
High deductibles can make accessing therapy challenging, but several solutions exist:
- Payment Plans: Some therapists offer flexible payment schedules to spread out costs.
- Sliding Scale Fees: Many therapists adjust rates based on your income, especially for clients who opt out of insurance. Note: Payments won’t count toward your deductible.
- University Clinics: Mental health clinics at universities often have graduate students providing therapy under supervision. These clinics generally offer affordable sliding scale fees.
Coverage for Online Therapy (Telehealth)
Online therapy, also known as telehealth, offers benefits such as:
- Saving time and transportation costs.
- Providing privacy and convenience for individuals with mobility or childcare challenges.
- Serving rural areas lacking nearby mental health services.
In recent years, many insurers have begun covering telehealth for in-network providers. However, platforms like BetterHelp may not accept insurance. Check the provider’s website to confirm coverage.
While telehealth is suitable for many, some prefer in-person sessions for personal comfort or specific therapeutic needs.
Finding an In-Network Therapist
- Online Directories: Use therapy directory websites to filter by location, specialty, and insurance.
- Insurance Provider Resources: Call your insurance company or visit their website for a list of in-network therapists. Be aware that these lists may lack details on a therapist’s specialization.
- Out-of-Network Options: If no in-network therapists meet your needs, contact your insurer to request more providers be added to their panel.
How Therapists Bill Health Insurance
Before starting therapy, clarify coverage with your insurance company. Specific billing codes often used include:
- 90791 (Intake Interview): A one-hour initial session to discuss history, symptoms, and treatment goals.
- 90837 (One-Hour Session): Sessions lasting 53 minutes or longer. Some treatments, like EMDR, require these longer sessions.
- 90834 (45-Minute Session): Traditional therapy appointments lasting 38 to 52 minutes.
- 90832 (30-Minute Session): Short sessions for specific needs, such as young children.
Confirm with your therapist which codes they use and check with your insurance for any session length restrictions or limits.
Navigating health insurance can be tricky, but asking the right questions and understanding how your plan works can make therapy more accessible. With this knowledge, you’ll be better prepared to find a therapist and take steps toward improving your mental health.