How Do You Find Out If Your Health Insurance Covers Therapy?

Does your health insurance plan cover therapy? You may not know the answer to this question right away. But that’s okay. After a few quick steps, you can review your current insurance policy and figure out whether your plan covers therapy and what portion of your therapy is covered.

Insurance Requirements

If you’re an employee of a company with 50 or more full-time employees, your employer is legally required to provide health insurance. It is not well-known, but health insurances are actually required to provide the same level of benefits for mental illnesses as for other physical disorders and diseases since the passing of the Mental Health Parity Act

Companies with fewer than 50 employees aren’t required to offer health insurance to employees at all. However, the Mental Health Parity Act applies here as well; if an employer chooses to sponsor health insurance for their employees, the insurance company is required to provide a level of benefits for mental illnesses equal to the level of benefits for physical ones.

Under the Affordable Care Act, any insurance plan purchased through the Health Insurance Marketplace must mandatorily cover 10 health benefits that are considered essential, including both mental health services and services for substance use disorders. In other words, if you purchased a plan through the Marketplace, you should have at least some mental health benefits coverage.

Where to Find Information

How do you investigate the details of your health insurance plan?

There are several options available to you.

  •       Call your health insurance provider. The most straightforward option is to call your health insurance provider directly. Most health insurance companies have a free hotline you can call to get answers to any questions you have regarding your policy or your benefits. If you have a health insurance card with your policy information, there should be a number on the back. Otherwise, you can find this contact information online. When you call, ask the representative if your policy has coverage for mental health services.
  •       Log into your account online. If you already have a registered account, log into that account and review your policy documents. If you haven’t registered online yet, now is a good time to do so; it typically only takes a few minutes. Depending on your insurance provider and the platform they use, you may be able to quickly search for benefits related to mental health services.
  •       Talk to HR. If you have insurance through your employer, talk to someone from human resources (HR). Your HR representative may be able to tell you more about the specific benefits of your insurance plan and how to take full advantage of those benefits.
  •       Ask available therapists. If you already know your insurance policy information, consider calling therapists and mental health service organizations directly to see if they accept your insurance and find out more details about the coverage you have. Some therapy groups will run your insurance information for you and tell out the amount of your copay for therapy ahead of the first session.

Mental Health Services Typically Covered

Most health insurance plans do have at least some coverage for mental health services. These are some of the most common types of coverage you’ll find:

  •       Psychiatric emergencies. Typically, insurance plans to cover psychiatric emergencies. If you suffer a psychotic break or a similarly dramatic shift in your mental health, your plan will cover your hospital visit and any other emergency services you need.
  •       Talk therapy and online therapy. Talk therapy is one of the most common types of psychological help available, and for good reason. Talk therapy sessions are usually covered by your health insurance policy, and you’ll typically have coverage for online therapy sessions as well. After all, online therapy is typically just as effective as in-person therapy.
  •       Addiction treatment. If you have a substance use disorder, or if you’re struggling to quit a negatively impactful substance, there may be coverage for the services you need.
  •       Behavioral health condition management. Inpatient and outpatient care may be covered as well if these forms of care are in service to behavioral health condition management.
  •       Prescription medications. In the course of your psychiatric treatment, you may be prescribed certain medications to help you manage your mental health conditions. Prescriptions are usually handled separately in health insurance plans, so you may have to look for this information elsewhere.

Important Questions to Ask

These are some of the most important questions to ask when getting more information about your health insurance coverage.

  •       Is there a copay? A copay is an amount of money you’re responsible for paying upfront for specific services, like talk therapy sessions.
  •       Is there a session cap? Some health insurance providers place an upper limit on the number of therapy sessions you can have in a given period of time. Session caps are rare these days. As long as there is a medical need for it, therapy sessions are usually covered without a session cap. 
  •       What is your deductible? In the insurance world, a deductible is the amount of money you’ll need to pay for services before your insurance plan starts to pay. Usually, there is a copay per therapy session, and the deductible is waived. But this varies widely from one plan to another.

Most modern health insurance policies do offer at least some coverage for mental health services. But it’s important to verify these benefits in advance. Spend some time investigating your policy and talking to your provider to make sure you understand the coverage available to you.

Photo by Kelly Sikkema on Unsplash