Does Insurance Cover Therapy?

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The affordability of mental healthcare is a significant consideration for many individuals considering professional help. Unfortunately, figuring out what services are covered by your insurance and what therapists take your insurance can be complex, confusing, and frustrating. If you have a hard time understanding all the terminology used and rules around accessing care, you’re not alone.

In this article, we break down the topic to what you need to know when accessing therapy, with or without insurance. With this knowledge, you will be better able to find a therapist who is a good fit for you and your budget.

At the most basic level, there are two primary ways you can pay for therapy in the United States:

1. Therapy with insurance
2. Therapy without insurance or with an out-of-network therapist

Therapy with an in-network therapist

Most insurance plans offer “behavioral health” benefits, which include services like outpatient mental health services, as well as more intensive treatment options like inpatient psychiatric care. However, each insurance plan can differ on what coverage looks like for each service. For instance, some plans may cover outpatient behavioral health services with a licensed clinician, only charging a small (e.g., $20) copay. Others may have larger cost-sharing amounts, or limit the number of sessions.

You might think that the more you pay in premiums each month, the less you’ll have to pay out of pocket, but this is not true in many cases. If you plan to utilize insurance to cover mental health costs, it’s worth delving into the specifics of the options available to you. Specifically, helpful information can be found in your Summary of Benefits and Coverage (SBC) document. You receive this document when enrolling in a health plan. The SBC will outline what behavioral services are covered, any limits or caps on services, and what you will be on the hook for paying.

Some questions to consider when reviewing your SBC document or when contacting your insurance company to confirm benefits include:

• Does my plan cover outpatient behavioral health services, including individual therapy?
• Are there limits on the number of therapy sessions my plan covers each year?
• Does my plan cover couples therapy, family therapy, or group therapy?
• What is my copay, coinsurance, or deductible for behavioral health visits?
• Does my plan cover virtual or telehealth therapy visits?

Unfortunately, not all therapists accept insurance, and those that do may have a limited number of openings for insurance clients. This means that many clients must pay out of pocket for their care.

Therapy without insurance

Paying out of pocket

Most therapists in the United States charge between $100 to $200 per individual therapy session, but fees can run much higher and occasionally lower, depending on where you live. For instance, therapists in New York often charge upwards of $200, often up to $350 per session, whereas therapists in more rural areas may charge closer to $100. In many markets, only about 25% of therapists accept insurance, although this number may be higher in some areas. Normally, therapists will require payment upfront for sessions.

Paying out of pocket may also be your only option for services either not covered by your insurance plan or for services above an allotted amount that your plan covers. However, if paying out of pocket imposes a significant financial burden, some therapists offer sliding scale payments, which allow you to pay a lower rate based on your income.

Out of network reimbursement

If you have insurance and you choose to go to a therapist outside of your network (that is, a therapist who doesn’t accept your insurance) you can still get some of the cost reimbursed by your insurance company through some plans. To receive reimbursement for out-of-network services, your insurance will likely require a “superbill.” It contains all the necessary information required by insurance companies to process a reimbursement claim, including the diagnostic code your clinician used for your care. This code helps validate to your insurance that your treatment was necessary.

Make sure to request a superbill from your provider to submit to your insurance company, and then follow up with your claim as necessary to ensure you receive reimbursement.

Common definitions

The world of health insurance can be complex, but some basic knowledge will help.

Deductible

The amount you pay for covered healthcare services before your insurance plan starts to pay; once you hit your deductible, your insurance plan will cover all further health expenditures for the year unless a specific service includes a copay or coinsurance

Copay

A fixed amount you pay for a covered service even after you’ve paid your deductible

Coinsurance

The percentage you’ll pay for treatment if you have reached your deductible; plans often have different coinsurance percentages depending on the plan type and provider network status

In-network status

Insurance companies make agreements with providers to include them in their insurance plans; therapists who are “in-network” with your plan will accept your insurance; you will still be responsible for payment, but fees will likely be lower (e.g., a $20 copay fee each session)

Out-of-network status

Providers who are “out of network” are those that do not have a deal with your insurance company; this means you have to pay for services out of pocket; if you submit a receipt (a superbill), your insurance plan may offer reimbursement for sessions

Superbill

A document that serves as a detailed invoice for the services provided during a therapy session (i.e., a receipt); superbills can be submitted to insurance companies for out-of-network providers in order to receive partial reimbursement for sessions

Sliding scale

A flexible fee structure where the therapist charges different clients different rates based on their ability to pay

Therapy can be a powerful tool in helping you work through and cope with challenges in your life and be the best version of yourself, but it’s not without a cost. Understanding fees and payment options and budgeting accordingly is a critical first step to accessing care.