If you’re one of the millions of Americans who are considering therapy, health insurance coverage may be a concern. If you have health insurance, chances are good that your policy provides some level of coverage.
To address the importance of and demand for sustaining mental wellness, most insurance companies offer some coverage for mental health services. But there are large differences between the benefits health insurers provide and the out-of-pocket costs you might be required to pay.
If you have health insurance through your job, it may or may not include coverage for therapy. Even if you have coverage, it’s up to you to decide whether or not you wish to use it for mental healthcare. In some instances, people choose to pay out of pocket for therapeutic services rather than claim coverage through their insurer. Why?
Insurance companies only pay for medically necessary services. They require a mental health diagnosis before they will pay claims. Some people are not comfortable with this.
A mental health condition diagnosis may range from acute stress to insufficient sleep syndrome, various phobias, mental illnesses, or a number of other descriptors. When it comes to insurance, each of these would have a code number that would go with an insurance claim.
Employer-sponsored insurance in companies of 50+ employees
Companies of 50 or more full-time workers are legally mandated to provide health insurance. This mandate does not specify that mental health services be included as a benefit. Even so, most large companies, including those that are self-insured, do provide health insurance that includes some coverage of therapeutic services.
Employer-sponsored insurance in companies under 50 employees
Small companies that employ under 50 people are not legally required to provide health insurance to their employees. However, for those who do, mental health services and substance use disorder services must be included, no matter where or how the plan is purchased.
Health Insurance Marketplace plans
Under the Affordable Care Act, all plans purchased through the Health Insurance Marketplace must cover 10 essential health benefits. These include mental health services and substance use disorder services.
All Marketplace plans, whether they’re state or federally managed, include coverage for mental health. This pertains to individual plans, family plans, and small business plans.
Plans and their coverage vary by state. States also offer multiple plan options, which vary in terms of their coverage.
All Marketplace plans must include
- behavioral health treatments, such as psychotherapy and counseling
- mental and behavioral health inpatient services
- coverage for pre-existing conditions
- no yearly or lifetime dollar limits on mental health coverage
- parity protections so that the copays, coinsurance, and deductibles for mental health services are the same or similar to those for medical and surgical benefits
CHIP (Children’s Health Insurance Program)
CHIP provides federal funding to states so that they can provide low-cost health insurance for low-income households with children who aren’t eligible for Medicaid. CHIP coverage varies from state to state, but most provide a full array of mental health services, including:
- counseling
- therapy
- medication management
- social work services
- peer supports
- substance use disorder treatments
The Mental Health Parity and Addiction Equity Act (MHPAE) requires most CHIP programs to provide parity protections for mental health and substance use disorder services. This ensures that copays, coinsurance, and deductibles for therapy and other mental health services are the same or comparable to those for medical and surgical benefits.
Medicaid
All state-run Medicaid plans are required to cover essential health benefits, including mental health and substance use services. Medicaid plans vary by state to state, but are also subject to the MHPAE.
Medicare
Original Medicare covers inpatient behavioral health and substance use services under Part A. If you’re hospitalized, you may have a deductible per benefit period as well as coinsurance costs.
Outpatient mental health services, including an annual depression screening, are covered under Part B. You may incur out-of-pocket costs for therapeutic services, including the Part B deductible, copays, and coinsurance.
If you have a Medicare Advantage (Part C) plan, it’ll automatically cover therapeutic services at the same level or greater than original Medicare. Your costs may vary from those associated with original Medicare.
Register and log on to your insurance account online
Your health insurance plan’s website should contain information about your coverage and costs you can expect. Since insurers offer a variety of plans, make sure you’re logged on and viewing your specific insurance plan.
If you’re required to choose a therapist that’s in your plan’s network, a list of providers should be available online. You can also call and ask that a local list be given to you by phone or mail.
Call your insurance provider
If you need additional information, call the toll-free number on the back of your insurance card and ask questions about the types of therapeutic services you can expect coverage for, as well as any out-of-pocket costs you may incur. If you have a diagnostic code, that may help you get accurate information.
Check with your company’s HR department
If you’re insured through employment and need additional help, contact your human resources (HR) department, if you feel comfortable doing so.
Ask the therapist if they accept your insurance
Therapists and other providers often change the insurance plans they’re willing to accept and may have opted out of your plan.
First, you can’t be penalized for having a pre-existing condition or prior diagnosis of any type of mental illness. For that reason, you should be entitled to mental health services from day one of your plan’s start date.
Things that might affect when insurance coverage kicks in:
- After prior authorization. Some services may require pre-authorization before you can obtain coverage for them.
- After meeting a deductible. You may also have to meet an out-of-pocket deductible before your plan starts to cover therapy. Based on the type of plan you have, this amount may be significant.
- After spending a minimum. In some instances, your plan may require that you pay a specified dollar amount on medical services before your coverage for therapy can start.
Some mental health services that may be covered by insurance include:
- psychiatric emergency services
- co-occurring medical and behavioral health conditions, such as coexisting addiction and depression. This is often referred to as a dual diagnosis.
- talking therapies, including psychotherapy and cognitive behavioral therapy
- unlimited outpatient sessions with a psychiatrist, clinical social worker, or clinical psychologist. In some instances, your insurer may cap the number of visits you’re allowed annually — unless your provider states in writing that they’re medically necessary for your care.
- telemedicine and online therapy
- inpatient behavioral health services received in a hospital or rehabilitative setting. Your plan may limit the length of your stay, or cap the dollar amount they’ll pay for your care per benefit period.
- addiction treatment
- medical detox services, including medications
Insurers only cover treatments that are considered medically necessary.
The breadth of coverage for specific therapeutic treatments, such as the length of rehab or hospital stays, also varies from plan to plan. So does the coverage and cost for medications you might be prescribed to treat your condition, both as an inpatient and as an outpatient.
Since insurers offer an array of plans, it’s not possible to give the specifics of each plan they cover. Here are some examples of coverage you may be able to get for therapy from specific insurers:
Does Blue Cross Blue Shield cover therapy?
The vast majority of Blue Cross Blue Shield insurance plans cover therapy.
If, however, your plan started before 2014 (when the Affordable Care Act was enacted) your plan may not cover therapy.
Blue Cross Blue Shield only covers evidence-based therapeutic services, such as psychoanalysis.
It doesn’t cover therapeutic services provided by a life coach or career coach.
It also doesn’t cover therapeutic services provided outside of a therapeutic setting, such as therapist-led systematic desensitization for phobias. These types of sessions may take place in a variety of locations, such as in a car if you have a phobia of driving, or on a plane if you have a phobia of flying.
Does Kaiser Permanente cover therapy?
Kaiser Permanente provides personalized treatment plans for mental health.
These plans typically cover one-on-one therapy with a professional such as a psychiatrist or nurse practitioner who specializes in mental health.
They also cover group therapy sessions and mental health classes.
Personalized stress management and addiction counseling are also included.
More insurers and examples
There are many places to start your search for a therapist or counselor that you want to work with, from asking people you know to talking with your primary care physician.
Start with the in-network list
If your insurer has a network of providers, this may be a good place to start looking for a therapist. Each therapist listed should have some information about their practice and specialty areas. These may include pediatrics, geriatrics, conditions such as obsessive-compulsive disorder or bipolar disorder, and their approaches to care.
Review lists from organizations for your location
The American Psychiatric Association provides a list of psychiatrists who have opted in to the database by zip code.
The American Psychological Association provides a list of psychologists by zip code.
You can also look for a therapist through the Open Path Psychotherapy Collective. This nonprofit nationwide network offers inexpensive therapeutic options for individuals, couples, and children.
If you intend to pay for therapy out of pocket, know that psychiatrists may charge different rates per hour than other types of mental health professionals, such as psychologists or licensed clinical social workers. This may also affect the cost of your copay, if you use your insurance to pay for therapy.
Paying for care
Understandably, the cost of therapy can be a big concern. Many therapists accept patients on a sliding scale. If you’re concerned about the cost of therapy, ask the therapist you’re considering if they’ll work with you on price or about any payment options they offer.
You can learn more about therapy at every budget level here.
If mental health symptoms are getting very difficult to manage, reach out for professional support. A mental health professional can help you work through your symptoms and help you start treatment.
Therapy is especially important if your symptoms are negatively affecting your daily life.
However, you don’t need a diagnosis to talk with a therapist or psychiatrist. They can also help when you’re dealing with feelings of stress or overwhelm.
Other reasons people go to therapy include:
- going through a major life transition
- experiencing grief
- managing relationship difficulties
Can insurance be used for therapy?
Yes, insurance can be used for therapy. Health insurance typically covers therapist visits and group therapy.
The level of coverage will vary based on your insurance provider and plan.
Additionally, since insurance only covers “medically necessary” services, some insurance companies may require a mental health diagnosis before they will pay claims.
How much does therapy cost?
The cost of therapy can vary widely depending on your location, your therapist, the type of your visit (in-person vs. remote), and other factors.
Generally, many therapists charge between $65 and $200 per session.
What does insurance cover for mental health?
Some mental health services typically covered by health insurance plans include:
- therapy
- group therapy
- addiction treatment
- inpatient behavioral services
- emergency mental health services
How does my therapist bill my insurance provider?
Most therapists will bill your insurance company for you. Your therapist will contact your insurance provider with the needed information, such as their name and address, your diagnosis, and the type of services you received.
Sometimes, you might pay a copay upfront. In other cases, you may need to pay the full price of your session and be reimbursed later.
Does insurance cover couples counseling?
If you’re planning on using insurance to pay for couples counseling, the rule requiring a mental health diagnosis will continue to apply in most cases: One partner must receive a diagnosis for insurance to cover it. Some people feel this has the potential to skew their therapeutic experience.
As with any diagnosis you receive, a mental health condition diagnosis may remain in your permanent record. In some instances, it may be accessed by background checking systems.
Most health insurance plans cover some level of therapeutic services. The amount of coverage you can expect will vary from plan to plan. In many instances, you’ll have a deductible to pay before your services are covered. Copays and coinsurance may also apply.
Services such as therapist visits, group therapy, and emergency mental healthcare are typically covered by health insurance plans. Rehabilitative services for addiction are also included.
Therapy can be expensive, with or without insurance. There are low-cost options that can help, such as therapists who take sliding scale payments and psychotherapeutic collectives that offer steeply reduced sessions.
If you need therapy but can’t afford it, talk to your doctor or another professional you trust, such as a clergy member or school guidance counselor. There are many ways that the financial barriers between you and the therapeutic care you need can be removed.
FAQs
Does Insurance Cover Therapy? When, How to Check, and More Tips? ›
Your mental health provider must share some information about your diagnosis and treatment plan with your health insurance company so they can determine which services are covered. However, the insurance company is required to keep this information confidential, according to HIPAA standards.
Do therapists report what you say to insurance? ›Your mental health provider must share some information about your diagnosis and treatment plan with your health insurance company so they can determine which services are covered. However, the insurance company is required to keep this information confidential, according to HIPAA standards.
Can insurance read therapy notes? ›Once your insurance company receives information about you from your therapist, there is no way to protect your privacy and confidentiality. Although insurance companies claim your information is confidential, their definition of “confidentiality” includes access to your records by anyone they say should have access.
Can I tell my therapist about anything? ›The short answer is that you can tell your therapist anything – and they hope that you do. It's a good idea to share as much as possible, because that's the only way they can help you.
Do therapists take notes after sessions? ›Not Every Therapist Takes Notes
Some may take notes after a session or only file specific worksheets or documents about a client. Not all therapists provide treatment in the same way, so it may not necessarily mean your therapist isn't paying attention or isn't trying to support you.
It may also be illegal, depending on what state you're in. That's the case in California, which has a “two party consent” requirement for recordings, so both the therapist and the client (and anyone else in the session if there are multiple clients) would be required to sign a consent form.
Will a therapist tell you your diagnosis? ›You have specific rights when disclosing your diagnosis as a client receiving therapy. For example, it's your right to ask your therapist to tell you if they believe you have a mental health condition. If you want a diagnosis, you can ask your therapist upfront.
Can you overshare in therapy? ›Sharing something you think is too sensitive or personal can be uncomfortable. But know you're not alone in thinking you've disclosed too much in therapy. When this happens, it can help to explore why you think you've overshared and talk it over with your therapist.
Why does my therapist watch my hands? ›Hands. Your client's hands can give you clues about how they're reacting to what comes up in the session. Trembling fingers can indicate anxiety or fear. Fists that clench or clutch the edges of clothing or furniture can suggest anger.
What are things that therapists don t talk about? ›Some of these topics include feeling incompetent; making mistakes; getting caught off guard by fee entanglements; becoming enraged at patients; managing illness; understanding sexual arousal and impulses; praying with patients as part of therapy; feeling ashamed; being fired; and not knowing what to do.
Is it OK to ask your therapist for an extra session? ›
No, it is not bad to ask for an earlier session. There's nothing wrong in asking for additional support if you need it. Most therapist will accommodate you when their schedule allows. I see my therapist 3 times a month, but I am told that if I need to call or see her during my skip week to let her know.
Is weekly therapy too much? ›A weekly session is a great place to start when beginning therapy. Generally, most patients will start with this frequency, then increase or decrease as needed. A weekly session is ideal for people who want to build skills related to things like mindfulness, coping, and communication.
Is it OK to ask your therapist how they are doing? ›So go ahead and ask the question, if you want to. However, it's also important—and okay—not to ask, if you'd rather not or if you're genuinely not interested or don't want to bring a personal component into the work. You have every right to protect your own boundaries, not just during this pandemic, but at all times.
What body language do therapists look for? ›Some of the things psychologists look for are your posture, hands, eye contact, facial expressions, and the position of your arms and legs. Your posture says a lot about your comfort level.
Why isn't my therapist helping? ›Asking Your Therapist for Insight
If you're noticing therapy isn't working, being honest with them can help you get answers. Even if you find that perhaps your expectations for therapy aren't realistic, sharing that with them can lead to fruitful insights. If you're noticing that you feel judged by them, let them know.
The number of recommended sessions varies by condition and treatment type, however, the majority of psychotherapy clients report feeling better after 3 months; those with depression and anxiety experience significant improvement after short and longer time frames, 1-2 months & 3-4.
Can I tell my therapist illegal activity? ›In most cases, discussing a past crime is protected by confidentiality rules. This means that you should be able to discuss a crime you committed with your therapist, and your therapist is sworn to secrecy.
Should you bring a notebook to therapy? ›Some clients want to remedy this by taking notes. You bring in a notepad and record the therapists' words as you relate your problems. Sure, this worked for you in school, and you're free to use therapy time however you want.
Are therapy sessions actually confidential? ›Confidentiality of information is applicable without any time limit unless otherwise specified by the originating party. The therapeutic relationship between a therapist and their client contains an abundance of confidential information. This means that it cannot be shared without the consent of the client.
Should you see a therapist or psychiatrist first? ›If the issue you're hoping to address is relationship-focused, say a problem at work or with a family member, you may find what you need from a psychologist. If you are experiencing debilitating mental health symptoms that are interfering with your daily life, a psychiatrist may be a good place to start.
Do therapists just tell you what you want to hear? ›
So while your therapist may guide your conversation in certain directions, it is not to offer you advice. It is so you can both learn more about what you truly want. And, eventually, so you can both learn what steps you think are most appropriate to take.
Do therapists know what they're doing? ›While your therapist might be an expert in certain areas of human psychology, that doesn't mean they know everything. Depending on how long they've practiced and how specialized they are, some of what you bring to the table might be new to them.
Do therapists record what you say? ›You therapist is required to maintain confidentiality about everything said in sessions between the two of you, just like a doctor is required to keep your records private. While there are laws and regulations in place to protect your privacy, confidentiality is also a key part of psychology's code of ethics.
Will a therapist tell you if they report you? ›In most cases, discussing a past crime is protected by confidentiality rules. This means that you should be able to discuss a crime you committed with your therapist, and your therapist is sworn to secrecy.
Should you write down what you want to say to your therapist? ›But writing things down allows you to look for patterns in your feelings and behaviors that you might want to address with your therapist, Small says. “For instance, a person may observe that they have been feeling inadequate or insecure and this would be a good thing to address with their therapist,” she says.
Do I have to tell my therapist everything? ›The amount of information you share with a therapist is entirely up to you. After all, you're the client. Still, the more honest you are with your therapist, the better. Giving your therapist a window into your thoughts, feelings, and experiences provides them with context and details, so they can best help you.
Can a therapist tell you to leave your partner? ›Should a Therapist Advise Divorce? As a general rule, it is considered unethical for mental health professionals to give advice at all. Our job is to help you learn to make those decisions yourself, not to tell you how to make them.
Do therapists tape sessions? ›A therapist does not have a legal or ethical obligation to allow a client to record sessions. Therefore, it is solely within the therapist's discretion as to whether to allow recordings of sessions.
What does my therapist write down? ›Therapists often jot down the significant dates, names of important people, and descriptions of symptoms.
What happens if you tell your therapist you hurt someone? ›If you tell your therapist that you want to harm a specific person or group of people, and the threat appears serious and/or imminent, then your therapist will report it to the police, inform the person who the serious threat is about, or both.
Should your therapist check on you? ›
They check in with you.
They should take the time to regularly ask you how you think your treatment is going and adapt accordingly. Sometimes, though, you simply might not be a good fit for each other. A good therapist will encourage you to speak up when it's not working.
None of the ethics boards that regulate mental health professionals specifically prohibit the use of touch or view it as unethical. There are times when your therapist may believe that it's more harmful to you not to initiate a hug. In some cases, nonsexual, therapeutic touch may be beneficial.
Should I tell my therapist I googled them? ›Googling a therapist can raise feelings of guilt for some clients, and I think that it is useful in therapy to discuss the relationship as openly as you feel able. I would suggest that having a conversation with your therapist around your internet search could be a great opportunity for good work in therapy.
What do I say in my first therapy session? ›Most likely, you'll find yourself talking about your current symptoms or struggles, as well saying a bit about your relationships, your interests, your strengths, and your goals. Most importantly, in that first session, you will begin making a connection with your therapist.