Health insurance coverage could be an issue if you are one of the many millions of Americans considering therapy. Chances are that you have some coverage if your health insurance covers it.
Most insurance companies provide some coverage for psychological health services to address the demand and importance of maintaining mental well-being. There are many differences in the benefits offered by health insurance companies and what out-of-pocket expenses you may be required to pay.
You may have coverage for therapy if you have work-related health insurance. You can decide if you want to use your coverage for mental health care. Sometimes, individuals choose to pay out-of-pocket for therapy services instead of claiming coverage through their insurance. What is the reason?
Only medically necessary services are covered by insurance companies. Before they will pay claims, they require a mental health diagnosis. This may not be something that everyone is comfortable with.
A diagnosis of a mental health condition could include acute stress, insufficient sleep syndrome, various fears, mental illness or any number of other descriptors. Each of these codes would be associated with an insurance claim.
Companies with 50+ employees may be eligible for employer-sponsored insurance
Employers with 50 full-time employees or more are legally required to offer health insurance. The mandate does not require that mental health services are included in the benefits. Nevertheless, large companies, even those that are self-insured offer health insurance that covers some therapeutic services.
Companies with fewer than 50 employees may be eligible for employer-sponsored insurance
Employing less than 50 employees, small businesses are not required to offer health insurance. However, those who have health insurance must include services for substance abuse disorders and mental health.
Plans for the Health Insurance Marketplace
All plans purchased through the Health Insurance Marketplace must provide 10 essential health benefits under the Affordable Care Act. These include services for substance abuse disorders and mental health.
All Marketplace plans, federally or state-managed, provide coverage for mental health. This applies to family plans and individual plans as well as small business plans.
Each state has its own plans and coverage. States offer a variety of plan options that vary in their coverage.
CHIP (Children’s Health Insurance Program).
CHIP is federal funding that states can use to provide low-cost insurance for low-income families with children who aren’t eligible for Medicaid. Although coverage for CHIP varies from one state to the next, most offer a wide range of mental health services.
- Management of medication
- Social work services
- Peer support
- Treatments for substance abuse disorders
The Mental Health Parity and Addiction Equity Act requires that all CHIP programs provide parity protections to mental health and substance abuse disorder services. This means that therapy and other mental services have copays, coinsurance and deductibles that are comparable to medical and surgical benefits.
All state-run Medicaid plans must cover essential health benefits. While Medicaid plans can vary from one state to another, they are all subject to the MHPAE.
Original Medicare includes inpatient behavioral health services and substance abuse services under Section A. You may be subject to a coinsurance cost and a deductible if you are hospitalized.
Part A covers outpatient mental health services including an annual depression screening. Out-of-pocket expenses for therapeutic services may occur, including the Part A deductible, copays and coinsurance.
A Medicare Advantage plan (Part C) will automatically cover you for therapeutic services at the same or higher level than original Medicare. You may have costs that are different from original Medicare.
Register online to access your insurance account
The website of your health insurance plan should include information about your coverage as well as the costs that you can expect. Insurers offer many plans so make sure that you log in and view your particular plan.
A list of providers online should be made available if you have to find a therapist within your plan’s network. You can also request a list of local providers by calling or writing.
Contact your insurance company
For more information, you can call the toll-free phone number at the back of your insurance card. Ask questions about what types of services you are covered for and any costs that you might incur. You may be able to get more accurate information if you have a diagnosis code.
Talk to your HR department.
If you are covered by employment, and feel you need more help, please contact your Human Resources (HR) department.
Ask your therapist whether they accept your insurance
Many providers, such as therapists, change the plans they accept. You may also have to opt out.
First, having a mental illness or pre-existing condition is not grounds for being penalized. You should have access to mental health services as soon as your plan starts.
These are some things that could affect the time when your insurance coverage kicks into effect:
- Prior authorization. You may need preauthorization for certain services before you can get coverage.
- After you have met your deductible. Before your plan covers therapy, you may need to pay an out-of pocket deductible. This amount can vary depending on which plan you have.
- After you have spent a minimum. Your plan might require you to pay a specific dollar amount for medical services before your therapy coverage can begin.
There are some mental health services that might be covered by insurance, such as:
- Services for psychiatric emergencies
- Co-occurring medical or behavioral conditions such as addiction and depression, are called co-morbidities. This is sometimes referred to as a “dual diagnosis”.
- Talking Therapies, which include psychotherapy and Cognitive Behavioral Therapy
- Unlimited outpatient sessions with a psychiatrist or clinical social worker . Your insurer may limit the number of visits you can make each year, unless your provider declares otherwise.
- Telemedicine and Online Therapy
- Inpatient behavioral health services provided in a hospital setting or rehabilitation facility. Your plan might limit the length of your stay or the amount they will pay per benefit period.
- Addiction Treatment
- Medical detox services include medications
Only medically necessary treatments are covered by insurance.
There are differences in the coverage available for certain therapeutic treatments. For example, different plans might cover the duration of rehabilitation or hospital stays. The cost and coverage of medications that you may be prescribed for your condition vary from one plan to the next.
If you plan to use insurance to pay for couples counselling, the rule that requires a mental diagnosis will still apply. However, one partner must be diagnosed with a mental disorder. This could lead to them having a less therapeutic experience.
A diagnosis of a mental disorder may be permanent, as with all other diagnoses. It may be possible to access it through background checking systems throughout your entire life.
There are many plans offered by insurers, so it is difficult to provide details about each one. Here are some examples for coverage that you might be eligible to receive from certain insurers.
Is Blue Cross Blue Shield covered for therapy?
Blue Cross Blue Shield insurance policies cover most therapy.
Your plan may not cover therapy if it was established before 2014, when the Affordable Care Act was passed.
Blue Cross Blue Shield does not cover psychoanalysis or other evidence-based therapies.
It does not cover the services of a career coach or life coach.
The policy does not cover therapy services that are provided outside of a therapeutic setting. For example, therapist-led systematic desensitization to phobias. These sessions can be held in many locations. For example, if you have fear of driving, you might have them in your car or in an airplane.
Is Kaiser Permanente able to cover therapy?
Kaiser Permanente offers personalized treatment plans to address mental health.
These plans usually cover one-on-1 therapy with a mental health professional, such as a psychiatrist and nurse practitioner.
They also offer group therapy sessions and classes in mental health.
You can also get personalized stress management and addiction counselling.
You have many options to begin your search for a counselor or therapist that you are interested in working with.
Start with the in network list
Your insurer may have a list of providers that you can use to search for a therapist. Each listed therapist should provide information about their practice as well as specialties. These could include pediatrics, geriatrics or conditions like obsessive compulsive disorder (or bipolar disorder), and their care approaches.
Check out the following lists of organizations that can help you locate your address
The American Psychiatric Association lists psychiatrists who have opted into the database by zip code.
The American Psychological Association lists psychologists by zip code.
The Open Path Psychology Collective can help you find a therapist. This non-profit network provides affordable therapeutic options for children, couples, and individuals.
You should be aware that psychiatrists can charge different rates for treatment than other mental health professionals such as licensed clinical social workers or psychologists. If you have insurance, this could impact the cost of your copay.
Many health insurance policies cover some form of therapy. You can expect different amounts of coverage depending on which plan you choose. You will often have to pay a deductible before you are covered. You may also be subject to coinsurance and copays.
Most health insurance plans cover services such as group therapy, therapist visits, and emergency mental health care. Also covered are rehabilitation services for addicts.
It is possible to pay a lot for therapy, whether you have insurance or not. You can find low-cost options, like therapists who accept sliding scale payments or psychotherapeutic collectives which offer significantly reduced sessions.
Talk to your doctor if you are unable to afford therapy. There are many options to remove financial obstacles that prevent you from receiving the treatment you need.