Understanding insurance for counseling services

If you have ever seen a therapist or tried to find one, you know that many don't accept insurance. There are various reasons for this, but in short insurance companies can be difficult to work with. They often have extraneous forms, they may frequently request records, they may deny claims, or they can take weeks or months to pay. Insurance companies often offer low rates as well, significantly undercutting what a therapist may charge for an hour of therapy.

Still, some therapists do accept insurance, but rarely do they accept every insurance. There are so many, and again, some are easier to work with or pay better than others.

When using insurance to help cover therapy costs, there are a few questions to be answered:

1) Which therapists accept my insurance? How do I find them?

2) If so, what kind of plan do I have? Do I have a deductible, and if so, does it apply to therapy?

3) Is my cost different, depending on whether services are in-person or online?

4) If a therapist doesn't accept my insurance, is it possible I could submit receipts to get part of it reimbursed by my insurance company?

If you want to use insurance to see a therapist, try searching in a directory like Psychology Today and see which therapists accept yours. There is even a filter for you to select your insurance, so it should show only participating providers. Even then, check with the provider if you reach out to confirm their participation. You can look at your insurance provider directory or cross reference it with something like Psychology Today as well.

Let's say you found a therapist and they do accept your insurance. Now you need to understand your benefits (and this is your responsibility since it is your insurance). Many plans have a copay to see an in-network provider for therapy. This can range from $15 to $80, depending on your plan and whether or not they consider a therapist to be a specialist. The best way to know would be to call your insurance customer service and ask them, "How much do I pay to see an in-network provider for outpatient mental health services?"

The other type of a plan is a deductible plan. This means you need to meet a deductible each year (usually calendar year, though some employers use a fiscal year) before your insurance company starts covering services. In this case you are expected to pay the provider's contracted rate with that insurance company until the deductible is met. For example, a provider charges $175 an hour for therapy. Their contracted rate with your insurance is $150, so you would pay $150 per session. If you meet your deductible, you would typically pay 10 or 20% of the contracted rate per session...in this case $15 or $30, while your insurance would pay the rest (for the remainder of the year until your deductible resets). One suggestion: If paying your deductible is difficult, master's level providers typically have lower contracted rates than doctoral level providers. For example, a doctoral level provider's rate may be $165 with your insurance company, while a master's level therapist's rate may be $130.

One caveat: Since the COVID-19 pandemic, some insurance companies have been covering telehealth services at 100% (this is true with many non-deductible plans, I am not sure about those with deductibles). This could mean that if your copay is $80 for an in-person session, and online appointment could be free. Be sure to check with your insurance company to see if there is any difference between in-person and virtual services.

Lastly, even if a provider doesn't accept your insurance, your plan may offer out-of-network benefits. This means that if they do, you could submit a statement of charges from your provider (they will often provide them monthly) to your insurance company for reimbursement. If you have out-of-network benefits and your insurance company will reimburse you at 65%, that could help significantly. For example, you see a provider 4 times in a month at $150 per session ($600 total) and your insurance reimburses you 65% of that, they would give you $390. So $600 in therapy charges becomes $210. Not all plans offer out-of-network benefits or that level of reimbursement, so check with your company if you want to know. If you don't have out-of-network benefits, you may still submit provider statements if you have an out-of-network deductible to meet. They could start reimbursing something if that occurs.

Hopefully this makes it less confusing as insurance applies to counseling services. I know that health insurance and the healthcare system can be difficult to navigate. Take care!