You’re planning to start therapy soon and want to use your health insurance because, let’s face it, it’s usually more cost effective for you! In-network is generally the most economical way to go, but many health plans also offer coverage if you go to an out-of-network provider. How do you decide which way to go, or might it work better for you to not use your insurance for therapy? If you’re thinking of using your insurance to cover counseling, these are some things you need to know before making that decision.
First, consider in-network vs. out-of-network options when using your insurance to cover the visit.
If a therapist is in-network, that means they have agreed to see clients under that health plan for a contracted rate—they can only charge you the co-pay (a flat $ amount) or the co-insurance amount (a % of the contracted rate) you would pay to see a specialist. I often hear that people have a hard time finding someone in-network, so if you go this route, plan to give yourself some time to find a therapist that’s taking new clients.
If a therapist is out-of-network they have made no such agreement with the insurance company. They will charge you the full session rate, which you would pay on the day of the session. The therapist then gives you what’s called a Superbill, which shows the date you were there, what you were there for, and how much you paid. You would then submit the Superbill to your insurance company for reimbursement. You can use a free service called Better to help you with submitting your Superbills to make it a bit easier. It bears noting that not all insurance companies or insurance plans provide their clients with out-of-network benefits. It may not be covered at all if you go out-of-network, so be sure to check your benefits. If you do have out-of-network benefits, you will probably have to meet an out-of-network deductible before insurance starts paying. The insurance company typically pays a percentage of the total session fee—after you meet your deductible.
Second, consider if you even want to use your insurance. You don’t have to use insurance for therapy, and in fact, there are some reasons that you may not want to!
Did you know that when you use your insurance to cover psychotherapy, your therapist is required to give you a mental health diagnosis? Insurance claims for therapy have to meet “medical necessity” in order to be covered, which means you have to have an official diagnosis for a mental illness. Your diagnosis then becomes part of your medical record. Also of note is that your insurance company can request access to your records to ensure that you are still meeting “medical necessity”, and to make sure documentation is up to date. Most insurance companies also limit the amount of time for sessions, usually 45 minutes, and may set limits on the number of sessions they will cover.
When choosing which way to go—in-network, out-of-network, or paying out of pocket, think about your particular situation and what’s most important to you. If money’s an issue and you just don’t have the funds to go out-of-network or pay the full fee , in-network may be a good option for you. If you have a bit more wiggle room financially, or want to make your own decision about who is the best fit for you, then think about going to an out-of-network provider or paying for therapy on your own.
Has this answered your questions about using insurance for therapy sessions? I hope so! If you still have questions—let me know!
Joan is a psychotherapist specializing in helping clients deal with anxiety and stress, move on from their past, and feel more confident in themselves and their relationships. You can schedule a free 15 minute phone consultation by sending an email, calling, or filling out this form.