Insurance
Does Insurance Cover Therapy?
Sometimes, and it depends on your plan. Here is which plans we work with, how to check your own therapy coverage in about ten minutes, and what your options are if we are out of network for you.
Plans We Work With
This list changes, and being on it does not guarantee that your specific plan covers therapy. We confirm your therapy coverage before your first session.
- Medicaid
- Medicare
SelectHealth plans we bill: Care, Choice, Med, Value, Share, Advantage, Access.
In progress: DMBA and UMR.
What Insurance Usually Does Not Cover
Insurance pays for treating a diagnosed mental health condition. That is the rule behind most coverage decisions, and it explains the gaps below. None of this means the work is less valuable, it just means the payer may not be the one funding it.
- Couples therapy is usually not covered, because relationship distress is not itself a diagnosis.
- Family therapy is often only covered when one family member has a covered diagnosis and the family sessions are part of treating it.
- Sessions beyond what your plan authorizes may be your responsibility even if earlier sessions were covered.
- Some plans exclude telehealth, or cover it at a different rate than in person care.
Ten minutes on the phone
The Questions to Ask Your Insurer
Call the member services number on the back of your insurance card and ask these. Write down the answers and the reference number for the call. This is the single most useful thing you can do before your first session.
- Is outpatient mental health therapy covered under my plan?
- What is my deductible, and how much of it have I met this year?
- Do I pay a copay or coinsurance per session, and how much?
- Do I need a prior authorization or a referral before I start?
- Is telehealth covered at the same rate as in person sessions?
- Is this provider in network, and what is my out of network benefit if not?
Insurance Terms, Explained
Insurers use a lot of terms that sound like they mean the same thing. Here is what each one actually means for you.
The amount you pay out of your own pocket each year before your plan starts paying its share. If your deductible is not met yet, you may pay the full session rate until it is. Deductibles usually reset at the start of the plan year.
A flat amount you pay per session, set by your plan. It does not change based on what the session costs. If your plan has a copay for mental health visits, that is your cost per session once any deductible is met.
A percentage of the session cost that you pay, rather than a flat amount. If your plan covers 80 percent, your coinsurance is the remaining 20 percent. Plans use either a copay or coinsurance, rarely both.
The most you will pay in a plan year before your insurer covers 100 percent of covered care. Deductible, copays and coinsurance usually count toward it. Premiums do not.
A provider who has a contract with your insurer and has agreed to a set rate. Your costs are usually lower in network, and your insurer pays us directly.
A provider without a contract with your insurer. You may still get partial reimbursement depending on your out of network benefit, but you pay us first and claim it back yourself.
Approval your insurer requires before they will cover certain care. Not every plan requires it for therapy, but if yours does and you skip it, the claim can be denied. Worth asking about before your first session.
The statement your insurer sends after a claim, often shortened to EOB. It is not a bill. It shows what was billed, what the plan paid, and what is left for you. Read it, but wait for an actual invoice before paying anything.
An itemized receipt with the diagnosis and billing codes your insurer needs. If we are out of network for you, you submit it yourself to claim reimbursement.
A written estimate of what your care will cost, which you have a right to under federal law if you are uninsured or not using insurance.
If We Are Out of Network for You
Being out of network does not mean you get nothing back. Many plans reimburse a portion of what you pay for an out of network therapist. The process is straightforward, but the amount is never guaranteed by us.
- We can provide a superbill, which is an itemized receipt with the codes your insurer needs.
- You pay us directly for the session, then submit the superbill to your insurer yourself.
- Your plan decides what to reimburse and when, based on your out of network benefit.
- Ask your insurer what percentage they reimburse and whether a separate out of network deductible applies.
A real choice, not a fallback
Some People Choose to Pay Privately
Using insurance is not automatically the better option, and plenty of people decide against it on purpose. It is worth knowing what the trade is before you choose.
- When you use insurance, your insurer receives a diagnosis, the dates of your sessions, and billing codes. That is how claims work.
- Some people prefer not to have a mental health diagnosis recorded with their insurer, and paying privately avoids that.
- Insurers can limit the number of sessions they will authorize. Paying privately means the length of your care is a clinical decision, not a coverage decision.
- Going to therapy is a private health matter. It is not a public record and does not appear on a standard background check.
Common Insurance Questions
These come up constantly. Our full FAQ has a lot more, including a dedicated insurance and payment section.
Insurance accepted. We verify your insurance before the time of service, so you know what you will pay.
When you use insurance, the insurer usually requires some information to pay for care, which can include a diagnosis and dates of service. If privacy is a concern, ask your therapist about what is shared and about private pay options.
Yes, we can offer superbills. Just ask the office.
Yes. Most of our sessions are between $150 and $175. Under federal law (the No Surprises Act), if you are uninsured or choose not to use insurance, you have the right to receive a Good Faith Estimate of expected costs for your care. Generally you can request one, or you will be given one when you schedule, and we will provide it within the timeframes the law requires. Please ask our office for details.
Going to therapy is a private health matter and is not a criminal or public record. It does not show up on a standard background check. If you use insurance, some information goes to the insurer as part of billing. If this concerns you, ask about private pay.
Tell Us What Is Going On
If you are not sure what you need yet, that is fine. We will help you figure out the next step.
Still Not Sure Where You Stand?
Send us your plan details and we will check what applies before you book anything. No pressure either way.