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  • Our Therapists
  • What We Treat
  • Services
  • About Us
  • Resources
    • Addiction Guide
      • Adderall Guide | Side Effects
      • Alcohol Addiction
      • Benzodiazepines
      • Cocaine Withdrawal
      • Fentanyl Guide | Addiction Treatment
      • Heroin Addiction Guide
      • Meth Guide
      • Online Alcoholics Anonymous
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      • Tramadol Guide | Side Effects | Addiction Treatment
      • Xanax Guide
      • How a Substance Abuse Counselor Helps
      • Spirituality in Addiction Treatment  
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      • How can counseling help depression?
      • Treatments for Borderline Personality Disorder (BPD)
    • Bipolar Disorder
      • Bipolar Disorder: Symptoms, Causes, Diagnosis, Treatment
      • Is bipolar disorder genetic and triggered later on?
      • Is cognitive therapy effective for bipolar disorder?
    • Children & Adolescents Guide
      • 10 Warning Signs of Teenage Mental Illness
      • Munchausen Syndrome
      • How Does Social Media Affect Teenagers’ Mental Health?
      • Oppositional Defiant Disorder
      • Spotting Types of Depression in Children
      • Teen Suicide
      • Top Tips For Parents
      • Video Game Therapy for ADHD
      • What is a Residential Mental Health Facility for Teenagers Like
      • Why Is Mental Health on the Rise Amongst Teenagers?
    • Is Social Media Ruining Our Self-Esteem? 
    • Mental Health Guide
      • COVID Counseling to Battle Mental Health Issues
      • Guide to Anxiety Medication
      • Disruptive Mood Dysregulation Disorder
      • High Functioning Depression | Signs | Symptoms
      • How Can We Prevent Mental Illness in Youth?
      • How Do You Help Someone with Avoidant Personality?
      • How Does Online Counseling Work for Mental Health?
      • How Can a Mental Health Counselor Help
      • Mental Breakdown
      • Schizoid Personality Disorder
      • Postpartum Depression
      • Types of Mood Disorders
      • The Toll of Grief and How to Cope with It
      • What are The Major Affective Disorders?
      • What Cognitive Psychology Teaches Us About How We Think
      • What Is Clinical Mental Health Counseling
      • What are mental health symptoms you should never ignore?
      • What is Bipolar II Disorder? Symptoms and Treatment
      • What is the Difference Between Manic and Hypomanic?
      • What is schizoaffective disorder?
      • Is seasonal affective disorder (SAD) a mental illness?
      • What is substance induced mood disorder?
      • Is Depression a Permanent Mental Disorder?
      • What is the prognosis for Major Depressive Disorder?
    • Marriage Counseling | Benefits
    • Pandemic Related Issues
      • COVID Counseling to Battle Mental Health Issues
      • Work Stress Post-Pandemic
      • Shocking Growth of Anxiety During the Pandemic
    • Relationship Issues
      • How to deal with toxic relationship?
      • How does a toxic relationship affect your mental health?
      • What is gaslighting in a relationship?
      • What is the best way to help a partner who has trust issues?
      • What’s the best way to work out relationship problems?
      • 10 ways to improve communication in relationships
    • Spirituality in Addiction Treatment  
    • Therapy
      • Can I See a Psychiatrist Without a Referral?
      • DBT Therapy for Adolescents
      • DCBT- Digital Cognitive Behavioral Therapy
      • Deep Brain Stimulation to Treat OCD
      • Do I Need a Referral to See a Therapist?
      • Family Therapy: Definition, Types, Techniques, and Efficacy
      • How Can Interpersonal Psychotherapy (IPT) Help Mental Disorders?
      • EMDR Therapy for Mental Health Conditions
      • Psychiatrist vs. Psychologist
      • Is Therapy Covered by Health Insurance?
      • Psychodynamic Therapy vs CBT
      • Psychotherapy
      • SMART Recovery
      • What Can Psychologists Treat
      • What is Group Therapy
      • What is Internal Family Systems Therapy
      • What Is the Role of the Counselor in Family Therapy
      • What Is Psychoanalysis
    • Trauma Bonding With Intimate Partner Violence
    • Teen Mental Health
      • Can a Minor Go to Therapy Without Parents Permission?
      • Teen Co-Occurring Disorders
      • What are the signs of depression in adolescents?
      • warning signs of suicide in adolescents
      • Mental Health Benefits of Exercise in Teens
      • How is the pandemic affecting mental health in teenagers?
    • Types of Disorder
      • Anti-Social Personality Disorder
      • Autism Spectrum Disorder
      • Avoidant Personality Disorder
      • Bipolar Disorder Symptoms | Causes | Diagnosis
      • Diagnosing and Treating an Adjustment Disorder
      • Histrionic Personality Disorder
      • Intermittent Explosive Disorder
      • Paranoid Personality Disorder
    • Veterans Guide
      • Functional Medicine for Military
      • Service Dogs Help Veterans with PTSD
    • Process Addiction
      • Gambling addiction
      • How do you know if you have an addictive personality?
      • What is Impulse-Control Disorder?
      • Process Addiction

Is Therapy Covered by Health Insurance?

Is therapy covered by health insurance? What specifications help a person seek therapy? Use this article to find the answer.

The Importance of Mental Health and Wellness

Mental health issues are among the leading causes of death and disability globally. In 2020, it was found that one in five adults in the U.S. (52.9 million) live with a mental illness.1 

Although treatment for most mental health conditions is somewhat widely available, it can be very costly. Unfortunately, many people do not have mental health insurance coverage to cover these therapy costs. According to the National Health Interview Survey (NHIS), in 2020, 31.2 million people under the age of sixty-five are uninsured. Thus, they are unable to have access to the quality care they very much need.2 

Therapy and Health Insurance

In recent years, there has been an increase in the adoption of therapy as a major part of treating and managing several medical conditions, especially mental health conditions. However, there has been one significant limiting factor to further adoption and, by extension, the success of therapy for improving medical conditions—cost. This has led to what is a very frequently asked question, is therapy covered by insurance?

There is no question that many have been able to enjoy reduced therapy costs with insurance, and there are even several physical and mental health care plans devoted to improving patients’ conditions. Nevertheless, there are still other forms of therapy that are not covered by health insurance. So, it is important for people to know exactly what health insurance is and the kind of treatments it covers.

What Is Health Insurance?

Health insurance, also known as medical insurance, helps provide cost coverage (fully or partially) for medical bills and expenditures. Simply put, health insurance allows people to only pay a certain amount of their medical bills out of pocket (partial coverage) or none at all (full coverage). Note that the type of health insurance determines if people pay fully from their pocket and get reimbursed by their health insurer later or if the insurer settles their medical expenses by communicating directly with their health care provider.

How Health Insurance Works

The average cost of mental health treatment or other forms of medical healthcare as a whole can be very expensive. In fact, a single visit to the doctor may cost hundreds of dollars. This, in essence, defeats the purpose of healthcare; after all, what good is medical treatment if people can’t even afford even the most basic of medical attention in the first place? This is where health insurance comes in. Basically, health insurance providers take on the majority of people’s medical expenses, leaving a much lower cost to pay out of pocket than the initial bill.

Costs

Keep in mind that health insurance is not free money. Health insurance works as a partner (via legally binding contracts) with an insurance provider of a person’s choosing. This partnership involves paying a certain premium (more or less a health insurance subscription fee) monthly or quarterly, varying from one provider to the next. After paying the premium, the health insurance provider will then be able to step in when people need assistance meeting their medical bills.

Coverage

Unfortunately, most insurance providers only cover preventive treatment fully. Other treatment types are settled on a “cost-sharing basis,” where clients will be required to pay a certain percentage of their medical bill (a deductible), and then the insurance company takes care of the rest.

In addition, health insurance providers usually have hospital or health care provider “networks” that they cover, so the only way to save money and avoid paying out of pocket is to seek treatment only through providers in the insurance network. A study from the National Alliance on Mental Illness (NAMI) found that 28% of people had to receive mental health therapy through an out-of-network therapist.3 

Is Therapy Covered by Health Insurance?

Health Insurance

Is therapy covered by insurance? This is a question that is asked quite frequently and does not have a straightforward answer. The most appropriate answer is—it depends. Usually, health insurance providers have a mental health insurance policy, so people should have access to insurance that covers mental health. The problem, however, usually lies in the type of therapy that the mental health insurance covers.

For example, most mental health insurance providers do not provide therapy insurance coverage for clients who would prefer online therapy despite it usually being cheaper and more accessible. Mental health therapy insurance providers may also not cover relatively new or alternative therapy types, so it’s important to confirm what type of mental health treatment is covered.

Can You See a Therapist on Insurance?

Again, the answer to this question is not a direct yes or no. It largely depends on several factors, such as the therapy insurance coverage type, therapy insurance provider, and the type of therapy people are opting for. Generally, mental health insurance coverage should take care of visits to a therapist, emergency mental care, group therapy, and possibly addiction rehabilitation therapy.

Thankfully, the general mental health coverage takes care of many expensive aspects, allowing clients to seek the care they need without paying costly medical bills in full. Nevertheless, people should always verify with their therapy insurance provider if their health insurance for mental illness will cover therapy visits.

What Kinds of Treatments Are Typically Covered by Insurance?

As mentioned earlier, not all therapy options have mental health insurance coverage, so it is important to know what is commonly covered. If you plan on using insurance for therapy, below are some insurance covered therapy options your insurance for therapy should cover:

  • Psychiatric emergency services
  • Co-occurring medical and behavioral health conditions
  • Talking therapies, including psychotherapy and cognitive behavioral therapy
  • Unlimited outpatient sessions
  • Telemedicine and online therapy
  • Inpatient behavioral health services received in a hospital or rehabilitative setting
  • Addiction treatment
  • Medical detox services, including medications

How Much Does Therapy Cost?

Therapy for the treatment and management of mental health conditions can be pretty expensive without insurance for therapy. When people go to a therapist not covered by insurance, they may end up spending hundreds or even thousands of dollars, depending on the factors surrounding the therapy option.

Factors That Influence the Cost of Therapy

Therapy rates usually differ depending on several factors, including:

  • The type of provider and their qualifications
  • The type of therapy
  • Insurance policy terms
  • Location
  • The duration of each session

Which Insurance Plans Cover Therapy?

The supplemental mental health insurance plan determines if clients will have access to mental health care at a reduced cost. Here are some insurance therapy options you can leverage to access quality mental health care at a reduced price:

  • Employer-sponsored health coverage
  • Health insurance purchased under the Affordable Care Act
  • Children’s Health Insurance Program (CHIP)
  • Medicaid programs

How Do You Know if Your Insurance Covers Therapy?

There are several methods to determine if your health insurance covers therapy. Some of these ways include the following:

  • Register and log on to your insurance account online
  • Call your insurance provider
  • Check with your company’s HR department
  • Ask the therapist if they accept your insurance

Again, it is important always to ascertain that your insurance covers the therapy options you are looking to employ before registering for them. Between 2012 and 2017, the Health Care Cost Institute reported that out-of-pocket spending on mental health services grew thirteen times faster than inpatient care.4 

When Does Insurance Start for Mental Health Services?

Ideally, insurance for mental health services should kick in as soon as the insurance agreement is concluded and the client has fulfilled all the stated requirements. However, before some providers cover therapy options, they may require their clients to fulfill some conditions. Some of these conditions may include:

After Prior Authorization

For some therapy insurance providers, clients may need to get prior approval before they have access to insurance coverage.

After Meeting a Deductible

Some therapy insurance providers will pause people’s therapy insurance plans until they fulfill an out-of-pocket deductible. This sum may be substantial depending on the plan.

After Spending a Minimum

Some insurance providers may require clients to pay a certain amount of money from the medical bill before they step in to pay for the rest.

Find More About Health Insurance Therapy at Pacific Beach Health

If you are looking for insurance therapy options to use as a cost-saving treatment option for your mental health condition or still have some inquiries about health insurance therapy, Pacific Beach Health is happy to help. Contact us today and get all of the answers you need.

Resources

  1. https://www.nimh.nih.gov/health/statistics/mental-illness
  2. https://www.cdc.gov/nchs/fastats/health-insurance.htm
  3. https://www.nami.org/Support-Education/Publications-Reports/Public-Policy-Reports/The-Doctor-is-Out
  4. https://www.npr.org/sections/health-shots/2019/06/07/730404539/mental-health-parity-is-still-an-elusive-goal-in-u-s-insurance-coverage

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