Find Therapy Covered By Insurance

Understanding key insurance terms will help simplify the process:

Insurance & Coverage Types

Health Maintenance Organization (HMO): A plan with lower premiums and out-of-pocket costs, but requires you to use in-network providers. Often requires selecting a Primary Care Physician (PCP) and referrals for specialty care. Services outside the network are typically not covered unless in emergencies.

Preferred Provider Organization (PPO): A more flexible plan that allows you to see both in- and out-of-network providers without referrals. Monthly premiums and deductibles are usually higher.

Exclusive Provider Organization (EPO): Like an HMO, but typically doesn’t require referrals to see specialists. Care is only covered if you use in-network providers (except emergencies).

Point-of-Service (POS): A hybrid plan requiring referrals from a PCP for specialty care, but offering some coverage for out-of-network care—usually at a higher cost.

High-Deductible Health Plan / Health Savings Account (HDHP / HSA): A plan with lower monthly premiums and higher deductibles. Often paired with a Health Savings Account (HSA), which lets you use pre-tax dollars for medical expenses like copays, coinsurance, and dental care.

Catastrophic Health Insurance: Low-cost, high-deductible plans for people under 30 or with a hardship exemption. Primarily designed to protect against worst-case scenarios.

COBRA: A law allowing you to temporarily continue employer-sponsored insurance after job loss—typically at full cost to you.

Marketplace Subsidies (ACA Plans): Income-based discounts on monthly premiums and out-of-pocket costs available through the federal or state health insurance marketplaces.

Payment & Cost Terms

Premium: The monthly fee you pay for health insurance.

Deductible: The amount you pay out-of-pocket for services before insurance begins covering costs.

Copay: A fixed fee you pay at the time of a medical visit, often varying by service type.

Coinsurance: A percentage of the service cost you pay after meeting your deductible.

Out-of-Pocket Maximum: The most you’ll pay in a year for covered care. After reaching this, your insurance pays 100% of covered services.

Sliding Scale: A fee model where rates are adjusted based on your income, often used by community clinics and mental health providers.

Fee-for-Service: A model where each service is billed separately. May involve paying upfront and submitting claims for reimbursement.

Paying Out-of-Pocket: When you pay the full cost of care directly without insurance or assistance.

Provider Types

In-Network Provider: A provider contracted with your insurance company. You’ll usually pay less to see them.

Out-of-Network Provider: A provider not contracted with your insurer. May result in higher costs or no coverage at all, depending on your plan.

Access & Assistance Programs

Charity Care Programs: Hospital or health system-run programs offering free or reduced-cost care for uninsured or underinsured individuals based on financial need.

Local Assistance Programs: Programs funded by state or local governments that help individuals who cannot afford healthcare services.

Grants from Nonprofit and Government Agencies: Funding provided to support access to mental health services for qualifying individuals. Includes local nonprofits and federal agencies like SAMHSA.

Federally Qualified Health Centers (FQHCs): Community-based clinics offering sliding-scale services, including mental health, regardless of insurance or income.

Community Mental Health Centers (CMHCs): Publicly funded clinics offering therapy, psychiatry, and case management to underserved populations.

Certified Community Behavioral Health Clinics (CCBHCs): Comprehensive care clinics for mental health and substance use that provide expanded services regardless of a person’s ability to pay.

State Welfare or Child and Family Services Funds: Funding and services for families and children needing support, often including mental health care. Learn more at childwelfare.gov.

CHIP (Children’s Health Insurance Program): Covers children in families with incomes too high for Medicaid but who can’t afford private insurance. Often includes mental health services.

Medicaid Managed Care: State-administered insurance plans provided through private insurers. Most Medicaid beneficiaries are enrolled in these and must identify which insurer manages their benefits.

U.S. Department of Veterans Affairs (VA) Funds: Health coverage and mental health services for U.S. veterans, including in-person, telehealth, and online resources. Learn more: mentalhealth.va.gov.

Indian Health Service / Tribal / Urban (I/T/U) Funds: Federal and tribal programs offering health and behavioral services to American Indian and Alaska Native communities.

Early and Periodic Screening, Diagnostic and Treatment (EPSDT): A Medicaid benefit for individuals under 21 that includes behavioral health screenings and services.

Step 1: Verify Your Therapy Coverage

Before you start looking for therapy covered by your insurance, make sure you have a clear understanding of your mental health care benefits as this can vary greatly depending on your insurer and specific policy.

How to check your coverage:

• Call customer service: Dial the number listed on the back of your insurance card, typically marked as "Behavioral Health Services" or "Member Services." You can say, “I'd like information on my mental health benefits and the costs associated with therapy sessions.”

Important questions to ask:

• Does my plan cover mental health or behavioral health services? (This may be listed under "behavioral health" or "mental health" benefits.)
• Does my plan cover both therapy and psychiatric care? (Some plans separate benefits for talk therapy vs. medication management.)
• Which types of providers are covered? (E.g., psychologists, licensed clinical social workers, marriage and family therapists, psychiatrists, psychiatric nurse practitioners.)
• Are both in-network and out-of-network providers covered? (If yes, what is the difference in reimbursement or copay/coinsurance rates?)
• Do I need a referral from my primary care physician (PCP)?
• Is prior authorization required before starting therapy or psychiatry? (Ask for a list of services that require preauthorization.)
• What is my deductible for mental health services? (Has it been met yet?)
• What is my copay or coinsurance for each visit?
• Are there separate costs for therapy vs. psychiatry?
• Are there tiered costs for different types of medications (e.g., generic vs. brand-name)?
• What pharmacy benefits does my plan offer for psychiatric prescriptions?
• How many therapy or psychiatry sessions are covered per year? (Some plans have session limits; others offer unlimited coverage.)
• Is continued approval required after a certain number of sessions?
• Are there diagnosis-based restrictions on coverage?
• Are there different coverage rules for telehealth vs. in-person visits?
• What’s the difference in coverage for inpatient vs. outpatient mental health services?
• If I need inpatient treatment, how many days are covered per year?

Additional tips:

• Customer support availability can vary; some insurance companies provide 24/7 support, while others operate during regular business hours.
• You can also typically find detailed information by logging into your online member portal and navigating to the mental or behavioral health section.

Step 2: Find a Therapist Covered by Your Insurance

Once you confirm coverage, find therapists covered by your insurance:

Where to look:

• Your insurer’s online provider directory for in-network therapists
• Specialized platforms like MiResource, which match therapists to your needs and help you find a therapist by insurance

Steps to confirm coverage:

• Verify directly with the therapist's office that they are in-network with your specific plan.
• Ask if they’re currently accepting new clients.
• Confirm whether they can verify your insurance benefits before scheduling your first appointment.

Step 3: Understand Referrals and Authorizations

Certain plans require additional steps before starting therapy:

• Referral from your primary care provider (PCP)
• Prior authorization from your insurance

Not completing these steps can lead to denied claims. Always clarify with both your provider and insurance what documentation is necessary.

Step 4: Clarify Session Limits and Covered Therapies

Insurance plans differ regarding therapy session coverage. Ask specifically:

• Are there limits on the number of sessions per year?
• Is couples or family therapy included?
• Is teletherapy covered like in-person therapy?
• Are specific therapy types (e.g., EMDR, CBT) covered?

Knowing these details upfront prevents unexpected costs.

Step 5: How Therapy Claims Work

Billing methods depend on whether your therapist is in-network or out-of-network:

• In-network providers typically bill your insurance directly. You pay only your copay or coinsurance.
• Out-of-network providers often require upfront payment, providing you with a "superbill" (itemized receipt) to submit to your insurer for partial reimbursement.

For out-of-network therapists, ask:

• Can you provide superbills?
• What's the typical reimbursement rate for my insurance?

Step 6: Estimate Your Costs

Before your first session, understand your potential out-of-pocket expenses:

• Deductible: Confirm if it has been met for the year.
• Copay or Coinsurance: Clarify whether it’s a flat fee or percentage-based.
• Check any session coverage limits.

Example:

If your plan has a $1,000 deductible, 20% coinsurance, and a $30 copay per session, a $150 therapy session would initially cost you the full $150 until the deductible is met. Afterwards, you'd only pay $30 per session.

Step 7: Know Your Mental Health Rights

U.S. federal law requires insurance plans to provide equal coverage for mental health services as for physical health (mental health parity). Your plan cannot:

• Charge higher copays for therapy than medical visits.
• Set more restrictive limits on mental health services compared to physical health services.

If you believe your plan is violating parity laws, you can file an appeal or complaint through your state's insurance regulatory agency.

Step 8: Using an HSA or FSA for Therapy

If you have a Health Savings Account (HSA) or Flexible Spending Account (FSA), these accounts can help you pay for therapy with pre-tax dollars, significantly reducing your costs. HSAs and FSAs can be especially useful if you have high deductibles or use out-of-network therapists.

Step 9: Addressing Denied Claims and Reimbursements

Occasionally, claims may be denied. Here's how to address such issues:

• Call your insurer immediately to find out why the claim was denied.
• Confirm billing details and diagnosis codes with your therapist.
• File an appeal promptly if you believe there's an error.

Appeals are common and often successful, so stay organized, document everything, and persist in resolving your issue.

If you're on a high deductible health plan (HDHP), you're not alone—and there are ways to make mental health care more affordable while maximizing your benefits.

1. Ask About Sliding Scale Fees Many therapists are willing to offer reduced rates based on your financial situation, even if you’re insured. Explain that you have a high deductible and ask if they offer a sliding scale or cash-pay rate. You can say: "I have insurance, but I’m responsible for the full cost of care until I meet my deductible. Do you offer a sliding scale or reduced rate for clients in this situation?"

2. Use Your HSA or FSA If you have a Health Savings Account (HSA) or Flexible Spending Account (FSA), you can use these tax-free dollars to pay for therapy sessions, reducing your overall out-of-pocket burden.

3. Compare Cash Pay vs. Insurance Rates In some cases, the therapist’s cash rate may be lower than what you’d pay through insurance before meeting your deductible. Ask your provider what the self-pay rate is and compare it to what you'd owe using insurance.

4. Track Your Spending Toward the Deductible Every therapy session paid out of pocket counts toward your deductible. Keep receipts and track payments to ensure your insurance company applies them correctly. Once the deductible is met, your plan will begin covering a greater portion of costs.

5. Choose In-Network Providers When Possible Even if you’re paying out of pocket initially, seeing an in-network provider ensures that future sessions (after meeting your deductible) will be covered at the highest rate possible.

6. Ask for Cost Estimates Up Front Before your first session, ask the therapist’s office to verify your benefits and provide an estimated cost per session. This helps you plan financially and avoid unexpected charges.

7. Explore Telehealth Options Virtual therapy is often more affordable than in-person care, and many therapists offer lower rates for telehealth appointments. These sessions may also be easier to fit into your schedule, helping you stay consistent with care.

8. Request an Out-of-Pocket Maximum Summary Your insurer can tell you how much you've paid toward your out-of-pocket max for the year. Knowing this amount helps you forecast when insurance will begin covering 100% of care.

What does it mean for a health care provider to be out-of-network?

Out-of-network providers are usually not covered by your health insurance policy. You typically have to pay out-of-pocket for out-of-network providers. This payment is much higher than if you go to an in-network provider. However, if your insurance company is a PPO or a POS, the insurance will pay for some of the costs of an out-of-network provider, depending on their policy.

If I have insurance, how much will my appointments cost?

The cost depends on the type of insurance plan you have and if your provider is in-network or out-of-network. Usually, all you have to pay when you’re going to a provider covered by your insurance company is a set amount of money called a copay (around $15-35). This amount is usually printed on the back of your insurance card. Typically, you end up paying more when going to providers that are not covered by your company (out-of-network). For more information, contact your insurance company and ask them about their rates for providers that are in-network and out-of-network.

What if my insurance does not have any in-network providers in my area?

If your insurance plan does not have any in-network providers offering in-person services near you, you should consider virtual care. As long as the provider is licensed to practice in your state, you can see them remotely. If there are no in-network providers offering virtual care in your state, you can consider searching for an out-of-network provider and checking with your insurance plan about their coverage for out-of-network care (number of sessions covered, reimbursement rates, co-pay required, among others).

Are there any disadvantages to using insurance?

The disadvantages of using insurance depend on the type of insurance plan that you have. Unfortunately, your insurance won’t cover the cost of a visit with just any provider. The most common disadvantage of using insurance is this network limitation, where most insurance companies–but not all–limit your coverage to in-network providers. Moreover, some insurance companies require you to get a referral from your primary care provider before going to specialists. Insurance companies may even limit the kind of mental health treatment you can receive. To learn more about what your insurance company covers, you can visit their website or call a representative.

What are some of the advantages I have when I use insurance?

Insurance greatly reduces the amount of money you pay upfront for your provider’s visits or medications. All insurance plans cover your healthcare from providers within their network, and some also cover out-of-network. Providers in your insurance company’s network can give you services for little to no out-of-pocket costs. If your insurance has prescription benefits, it will also cover all or some of the medications that you need to get from the pharmacy. For example, a $300 prescription might cost you only $10 out-of-pocket.

Insurance also greatly reduces the amount of money you pay for emergency care. Medical emergencies are extremely costly, even if it’s just the cost of checking into the hospital for one night. This cost rises if you need more intensive services, such as staying at a rehabilitation center.

What are some advantages of paying out-of-pocket?

An important consideration is a flexibility of paying out-of-pocket. You are not constrained to meet certain requirements, such as a referral from your primary care provider or condition/treatment coverage limits, to obtain care. You also do not have to fill out paperwork to get prior approval for care. You also have more freedom to choose duration, focus, frequency, and treatment modality best suited to your needs.

Are there any disadvantages of paying out-of-pocket?

The primary disadvantage is cost. Given that the biggest obstacle is immediate expense, some mental health providers or centers offer reduced rates based on the client’s income or family size. To learn more about this, check out our payment assistance section. Mental health providers are free to set their own rates and offer a sliding scale when clients are paying out-of-pocket. This approach to fee setting can lead to paying even less than with insurance depending on where you fit on the sliding scale, duration of treatment, and details of your insurance plan. It is helpful that when you first see your provider that you communicate what you can afford, while also showing a willingness to be flexible. Ask about a sliding fee scale if your finances will limit your ability to seek care.

Does it matter what I use to pay for my services?

The method of payment you use to pay for your services depends on where you go for your mental health care. Most providers take debit/credit cards, cash, or check. Some mental health providers allow you to use other modes of payment such as PayPal. You can also take out a loan in order to pay for medical-related bills.

If I have a mental health diagnosis, can my insurance classify this as a preexisting condition and change my benefits?

You cannot be charged more or refused coverage because you have a pre-existing condition. Once you have insurance, the company cannot refuse to cover treatment on the basis of it being a pre-existing condition.

Will my parents know I’m going to a mental health provider if I am on their insurance plan?

Mental health providers are required, by law, to keep your information confidential. However, if you are on your parents’ insurance plan or if they receive your medical bills and statements, they might see some information (e.g., type of service and date) on the bill. Changing the address for the bills and statements or, if on their insurance, paying out-of-pocket for the full cost of the mental health service would ensure this information is kept private from your parents.

Is there anything I can do to get my medication covered, if my insurance plan refuses to cover it?

You can file for a drug exemption request. Generally, this process requires your provider to write an explanation as to why the drug is appropriate for your mental health condition. You must wait for the exception to be approved or denied. However, it is important to check with your insurance company on their process for requesting a drug exemption because this varies by plan.

Can I go to a mental health provider without clarifying with my insurance company that they will cover the cost?

Not all health insurance companies require precertification or a referral before seeing a mental health provider. However, there are many plans that do require you to have precertification or a referral from your primary care provider. Thus, it is important to check what benefits your insurance covers beforehand.

How do I get my insurance to reimburse this cost if I pay out of pocket?

First, make sure your insurance covers these services. You want to make sure that the services that you are interested in getting reimbursed are within your benefits by checking your EOB. Furthermore, consider if these services are in-network or out-of-network. Some insurances will only cover in-network services, so it’s important to check if your insurance also covers services from out-of-network providers. You can find this information on your insurance’s website or by calling and talking to a representative.

Second, follow these steps to get reimbursed by your insurance. In some cases, your provider can fill out the form to get their services reimbursed. If your provider does not fill out the reimbursement form, you will have to do this. Here are the steps to file this claim:

1. Request receipts: If the services are within your benefits, you will need to request itemized receipts from your provider to add to your claim.
2. Download claim: To get this claim you can download it from your insurance's website. This form will have further instructions regarding the logistical information needed to add to the claim.
3. Cover your bases: Claims may get rejected, so it’s important that the information is correct. Moreover, if a claim was lost or had slight mistakes, it’s handy to keep a copy just in case.

How do I get precertification for a service?

In most cases, your provider or hospital will request precertifications. In the event that you have to request it, you can request this online, via fax, or by talking to a representative. Requests are prioritized based on medical necessity. Mental health care and medications on the precertification list of your insurance plan can require you to notify or get a coverage determination. In the case of notification, you just have to file a form to record the mental health care service you will be receiving, but the insurance company does not have to make a decision on whether to accept to cover you. In the case of precertification for coverage determination, the insurance company will look at plan documents and clinical information to determine whether to cover that mental health care service or medication. In the case of emergency services that are on the precertification list, prior authorization is typically not required. Instead you have to notify within 24 hours or the next business day.

For example, your insurance will have a list of medications that are covered, but some are not on this list and require precertification. If you go to your pharmacy, your pharmacist will contact your insurance to get precertification. Your insurance will then request a precertification from your doctor. Your doctor will express the medical necessity of your medication, and then your insurance will decide based on a medical necessity criteria whether your insurance can cover the medication. Your pharmacy will then alert you as to whether or not your medication was approved.

Do I have to notify my insurance company when I move to a different address or state?

Depending on where you move, your insurance policy may change. If you move to a different state, it is very important that you notify your insurance company because you may need to switch to a new plan or a different company. You can follow these steps to update your address online. You can also call your insurance and talk to a representative. If you move within your state, your plan won’t change, it is only important for you to update your address to receive mail from your insurance. However, the exception is that some HMO plans provide service coverage for specific counties, so an address change may mean going to a different facility and network of providers.

How do I know if my insurance covers mental health care?

To learn more about your insurance company’s policies, you can look at the website or call to talk to a representative.

It’s important to know that some insurance companies outsource part of their mental health coverage to other companies. Again, you can look at the website or call to talk to a representative to find out if your insurance company outsources your mental health coverage.

Will insurance cover all of my medications’ cost completely?

The amount you pay for medications is based on your insurance. Some medications have a copay, some are covered in full, and some are not covered at all. There are several categories of medication: preferred, non-preferred, generic, and name-brand. Each insurance plan has a Prescription Drug List (PDL) that are preferred medications. Preferred medications have the best overall value, which is determined by your insurance and based on effectiveness and safety. Within the PDL there are “generic” and “name-brand” medications. Generic medications are copies of name-brands that work the same and have the same active ingredient, but have a lower copay. A name-brand medication tends to be prescribed if the generic equivalent is not available. This availability depends on the pharmacy and the drug. Medications are organized in tiers based on the amount you pay. The first tier has the lowest copay, and the last tier has the highest copay. The first tier is “preferred generic,” the second tier is “non-preferred generic,” the third tier is “preferred name-brand,” and the fourth tier is “non-preferred name-brand.”

Will my plan cover online therapy?

When in-office visits aren’t feasible, online therapy that accepts insurance can be just as effective—and is now covered by most plans at the same rate as in-person care. To confirm:

1. Check your benefits: Log into your member portal or call the number on your card to see if teletherapy is covered, whether prior authorization is required, and any session limits.
2. Verify with the therapist: Before booking, ask “Are your virtual sessions in-network with my specific plan?”