Is Therapy Covered By Insurance?

Affordable Care Act (ACA)-compliant healthcare plans are required to cover most mental health disorders, such as major depressive disorder, autism, bipolar disorder, panic disorder, schizophrenia and obsessive-compulsive disorder. Some providers cover telehealth therapy so you can receive care without leaving your home. Review your health insurance coverage or contact your carrier to see what mental health benefits are included in your policy.

When Does Insurance Cover Therapy?

The ACA lists therapy as an essential health benefit in all ACA health plans, which are purchased through your state’s health insurance marketplace. Coverage should extend to most mental health disorders, substance use disorders and the treatment for chemical and alcohol addiction. Covered treatments and coverage limits will depend on your insurance plan and company.

Most types of health insurance plans should cover therapy, including:

• Plans purchased through your state’s health insurance marketplace
• Employer-sponsored group health coverage
• Medicare (Part B covers depression screenings, individual and group psychotherapy, medication management, psychiatric evaluations and more)
• Medicaid
• Children’s Health Insurance Program (coverage for children whose families do not qualify for Medicaid)

Does Insurance Cover Therapist Visits?

Your health insurance coverage will often cover therapist visits, including in-person sessions, telehealth and group therapy. However, your insurance company may have an annual cap on the number of therapy sessions they will cover. If this is the case, and you need continued treatment, your therapist can submit a letter to your insurance provider on your behalf requesting additional coverage for ongoing service.

In the initial therapy session, your therapist typically asks multiple questions so they can submit the correct current procedural terminology (CPT) code for your treatment. These codes are submitted to insurance companies as shorthand and let the provider know how long the session was and whether it was an individual, group or telehealth session. Common CPT codes include:

• 90837: Psychotherapy, 60 mins with patient
• 90834: Psychotherapy, 45 mins with patient
• 90791: Psychiatric diagnostic evaluation
• 90847: Family psychotherapy (conjoint psychotherapy) with the patient present, 50 minutes
• 90834-95: Psychotherapy 45 min, telehealth
• 90853: Group psychotherapy (other than of a multiple-family group)
• 90832: Psychotherapy, 30 minutes with patient
• 90837-95: Psychotherapy, 60 mins, telehealth modifier
• 97803: Medical nutrition therapy; intervention and re-assessment, individual, face-to-face with the patient, 15 minutes each
• 99214: Office or another outpatient visit for the evaluation and management of an established patient, requiring a medically appropriate history and/or examination and moderate level of medical decision making

Your therapist will submit this information to your insurance company, including your diagnosis and recommendations for treatment, and your provider should cover the costs. Keep in mind, you may need to pay a copay or meet your plan’s deductible before your plan’s coverage kicks in.

You won’t have to file a claim with your insurance provider when going to therapy. The therapist will send in the pertinent information to your carrier.

Does Insurance Cover Mental Health Services?

Federal law asserts that essential benefits will include behavioral and mental health services, like counseling, psychotherapy, substance use disorder treatment and inpatient mental and behavioral health services. Care must be managed the same way as it would for physical medical services but your provider is usually allowed to place limits on the number of covered therapy sessions. Out-of-pocket costs, like deductibles and copays, can still apply.

Get Personalized Health Insurance Quotes Here

How Do I Know if My Health Insurance Provider Covers Therapy?

The simplest way to confirm if your health plan covers therapy services is to ask your provider. The representative you speak with will be able to tell you what your plan will cover and whether you’ll need to pay a copay or meet your deductible. They can also provide a list of therapists and mental health practitioners within the plan network.

You can also look up therapists in your area through an online search. Many of them will show which insurance companies they work with plus pricing. Additionally, you can log in to your patient portal through your healthcare provider’s website and see a list of your benefits.

Don’t be put off by seeking therapy from an out-of-network provider. This may be the case if you have particular therapeutic requirements that need to be met and cannot be addressed by an in-network practitioner. If this fits your situation, start by asking your insurance carrier if any out-of-network benefits exist. If there are, you may ask the therapist you go to if they can issue a superbill to your provider so they can reimburse either cover or reimburse you for a portion of the cost. A superbill is a document similar to a receipt or invoice that itemizes the services you have received under the therapist's care. Providers who can submit a superbill generally include:

• Psychologists
• Counselors and psychotherapists (therapists)
• Clinical social workers
• Psychiatrists
• Psychiatric nurse practitioners
• Mental health or substance use clinics or facilities

Once the superbill is submitted, your insurance company will decide what they are willing to pay. For instance, you may have a bill for $200 worth of therapy. Your insurance may pay $150 and leave the remaining $50 for you to cover.

What Types of Therapy are Covered by Insurance?

Your insurance can cover a wide range of therapy, including:

Major depressive disorder Bipolar disorder Schizophrenia Bulimia nervosa Obsessive-compulsive disorder

Autism or pervasive developmental disorder Panic disorder Schizoaffective disorder Anorexia nervosa Severe emotional disturbances in children under age 18

Users can log in to their healthcare provider’s online portal and find treatment programs in their area.

• Adult treatment programs: Your health insurance should offer treatment programs tailored for adults who experience depression, anxiety, suicidal ideation and other emotional/ behavioral problems. Programs may include partial hospitalization, inpatient hospital care, outpatient specialty care and psychiatric home care.
• Child and adolescent programs: Your healthcare policy can include programs to help children and teens with anxiety, depression, bipolar disorder, substance use, aggressive behavior and self-harm.
• Cognitive treatment programs: Your health insurance can grant you access to programs that treat mood and anxiety disorders, including major depression, bipolar disorder, OCD and post-traumatic stress disorder (PTSD).
• Dual recovery treatment programs: Your healthcare policy will likely provide treatment for substance abuse and behavioral health issues (co-occurring) that are designed to help patients understand the connection between mental health and addiction.
• Eating disorder treatment programs: Your healthcare coverage may include hospitalization and intensive outpatient treatment for those struggling with bulimia, anorexia or binge eating disorders.
• Older adult service programs: Your health insurance provider may have mental health treatment programs tailored specifically to the elderly, including outpatient services for anxiety, depression and suicidal ideation.

Does Insurance Cover Online Therapy?

Your health insurance will likely cover online therapy (telehealth) but this can vary by company. Since the COVID-19 pandemic, telehealth has become a more popular option for people due to its several advantages:

• Save time and avoid sitting in traffic while commuting to the therapist’s office.
• If you don’t have a vehicle, you don’t have to make transportation arrangements to make your appointment.
• Enjoy the privacy of receiving therapy within the walls of your own home.
• Telehealth is accessible whether you want to do it through your phone, computer or tablet.
• Save on daycare costs since you can complete a therapy session while staying at home with the children.
• People with mobility issues don’t have to undergo the hassle of commuting to and from the therapist’s office.
• People who have compromised immune systems do not have to risk leaving their homes and becoming ill.
• People living in remote areas do not have to travel great distances to get mental health services.

What Options Are Available if I Have No Coverage for Mental Health Services?

There are several avenues available if your financial situation makes you hesitant to seek mental health services. Look below at what your options are so you can get the help you need.

The National Alliance for Mental Illness

The National Alliance on Mental Illness (NAMI) offers free 24/7 assistance through a helpline that can be reached by calling 1-800-950-6264. You can also text NAMI at 741741 for more information.

Seek Services at a University

Low-cost mental health services may be available from interns and residents at university hospitals on a sliding scale.

Open Path

Open Path Psychotherapy Collective is a non-profit that lets users search their area for affordable therapists. Costs generally range between $30 and $80 depending on whether you want individual therapy or group, couple or family therapy.

Employee Assistance Programs

Your employer may offer mental health benefits through their Employee Assistance Program (EAP), making these benefits free to you. See your employee handbook or check with your human resource department to see what your EAP benefits options are available. Keep in mind there will likely be a limit on the number of free EAP benefits you can receive per year.

Disability Benefits

You can potentially receive financial aid through Part B of Medicare if you have a chronic mental health issue that inhibits your ability to work. If so, those with a qualified diagnosis may qualify for Medicare before reaching the age of 65.

Through Medicaid, individual states can also enact “medically needy programs” for those with significant health needs with an income too high to traditionally qualify.

Negotiate

The therapist you’re seeing may adjust their pricing to accommodate your budget.

It is not uncommon for therapists to use a sliding scale based on your income when calculating what they charge for services

Those with lower incomes will spend less for great care. You can also ask whether there are discounts for paying in cash if you have the means.

Get Personalized Health Insurance Quotes Here

Key Takeaways All ACA-compliant healthcare plans are required to cover therapy services for most mental health disorders. Log in to your health insurance provider’s online portal or call your carrier to see what mental health treatments are covered by your plan. Your health insurance will likely cover telehealth therapy so you don’t have to leave your home. Disorders covered by your insurance include but are not limited to major depressive disorder, autism, bipolar disorder, panic disorder, schizophrenia and obsessive-compulsive disorder. There are cheap alternatives to finding therapy if you don’t have health insurance.

Don't let your mental well-being take a backseat. Enter your zip code below or call 855.214.2291 and SmartFinancial will send you your free health insurance quotes.