Table of ContentsView AllTable of ContentsHow Does Health Insurance Cover Therapy?Types of Therapy CoveredPaying For TherapyGetting ReimbursedIf You Are Uninsured
Table of ContentsView All
View All
Table of Contents
How Does Health Insurance Cover Therapy?
Types of Therapy Covered
Paying For Therapy
Getting Reimbursed
If You Are Uninsured
Close
Therapycan be an invaluable resource to treat a variety of mental health conditions, but like many forms of medical care in the United States, many people cannot afford thecost of treatment.
According to the electronic health record platform SimplePractice, the average cost of a session in the United States varies from $100 to $200.
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Until recently, manyhealth insurance plansin the United States excluded coverage of mental health care. Even if someone had health insurance, their plan might exclude therapy services. However, an amendment to the Affordable Care Act known as theMental Health Parity and Addiction Equity Act(MHPAEA), passed in 2008, required insurance plans to cover mental health.
This means, if you have health insurance, you most likely have some coverage for mental health services. You must have adiagnosable mental health conditionin order for services to be covered, as your therapist will have to use the code for your diagnosis during billing if they bill to your insurance company.
Some insurance plans exclude certain diagnoses from coverage. For example, some plans do not coveradjustment disordersbecause these are considered short-term rather than chronic conditions.
Copays and Deductibles
Mostmental health planshave either a copay or a deductible. If you have a copay plan, this means you pay a set amount each time you have an appointment. For example, if your plan’s copay is $40, you will pay $40 per session, and your insurance will cover the remainder of your balance.
If you have a deductible plan, you pay the full cost of services out-of-pocket until your deductible is met, at which time your insurance will start covering a percentage of your costs. If your plan has a $3,500 deductible, you will pay $3,500 for all of your medical costs out-of-pocket before your insurance starts covering a portion of your sessions.
Most therapists have information about their session rates on their websites. However, if your therapist is in-network with your insurance plan, they agree to a negotiated rate with the insurance company for your sessions.
If, for instance, your therapist charges $150 for a 45-minute session but has a negotiated rate with your insurance company of $120 per session, you would pay $120 per session until you reach your deductible.
What Types of Therapy Are Covered By Insurance?
If you plan to use your insurance to cover your therapy costs, ask your provider what billing codes they use to code their sessions. Then, call your insurance’s customer service number and ask if your plan covers those billing codes.
The most common CPT codes used for therapy are:
Does Medicaid Cover Therapy?
Many electronic health records include a client portal where you can pay for sessions via credit or debit card, and providers often accept cash or check payments. You can use a health savings account (HSA) to cover your out-of-pocket therapy costs.
Applications for transferring money such as Venmo, PayPal, and CashApp are not HIPAA-compliant (meaning they do not meet federal standards for protecting yourprivate healthcare information) and should not be used to pay for therapy. It is your provider’s responsibility to only accept HIPAA-compliant payment methods.
If you have a high deductible plan, your therapist mightallow you to set up a payment planto pay down your balance after your insurance begins covering sessions. For example, if your deductible has you paying $100 per session and your deductible is $1,000, your therapist could agree for you to pay $50 per week until the deductible is paid off.
Once your therapist has billed your insurance, their contract with your insurance company requires them to charge you the contracted rate for your sessions. While they can work with you on a payment plan, they might not be permitted to reduce the total balance owed based on that contract.
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How to Get Reimbursed for Therapy
Some therapists do not accept insurance or only accept certain insurances. This is because billing insurance is time-consuming, companies often delay payment, and insurance companies can initiate “clawbacks” where they take back payment up to five years after service was provided.
Many therapists cannot afford to deal with these issues and still provide their clients with the best possible care.
Some companies also limit how many providers can accept their insurance. Before a therapist can bill an insurance company, they must complete a credentialing application with that company. Essentially, they apply to be allowed to accept the insurance. If your therapist attempted to credential with your insurance company but was told their panel is full, you can call and request that they expand their panel if you were unable to find anin-network providerwith availability to see you.
If a therapist does not accept your insurance, they are considered out-of-network. You can request that your therapist put together a Super Bill or an invoice about the services you received and what you paid for them. A Super Bill requires that you pay for services first but you can submit it to your insurance company and potentially be reimbursed with some or all of your therapy costs.
If youdo not have insurance, you might not be able to afford the out-of-pocket cost of therapy. Many therapists havesliding scalespots in their practice, which allow clients to pay for sessions based on their income or financial means.
Many providers have information about sliding scale fees on their website, andOpen Path Collective, an online therapy directory designed for people who are uninsured or underinsured, has resources for people seeking a therapist who offers sliding scale rates.
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2 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Centers for Medicare & Medicaid Services.The Mental Health Parity and Addiction Equity Act (MHPAEA).
Hannah Owens, LMSW
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