Using Insurance for Psychotherapy

I am on a number of insurance panels and a number of my clients use their insurance to cover the costs of psychotherapy. I’m happy to provide this option to my clients. In this way, many who perhaps could not afford the cost of weekly appointments are able to do so. In these situations, clients pay their co-payment (and any deductible). And if a client has insurance for which I am not a network provider, I am happy to give that client a receipt each month which she can submit to get some reimbursement (providing the client has what is called “out-of-network benefit”).

Given my experience working with insurance companies, I thought that I would provide some responses to questions I am frequently asked. The first place to begin if you are thinking of using insurance for psychotherapy is to call the customer service number on the back of your card. Here are some questions to ask:

• Do I have mental health benefits? Most insurance plans do cover for mental health treatment. That part of the benefit is referred to as behavioral health. Sometimes an insurance company contracts with another company to cover these benefits. However, not all plans do provide for mental health treatment.
• What is my deductible and has it been met? In my experience, often mental health treatment is not subject to one’s annual medical deductible. However, in some cases it is. And in other cases, mental health treatment may have its own deductible.
• How many sessions per calendar year does my plan cover? Often there is a set number of psychotherapy sessions covered. These sessions would also include seeing a psychiatrist. However, for certain mental health conditions, those that meet the criteria for severe mental illness, there often is unlimited number of sessions (what is referred to as “subject to medical necessity”). If you have an HMO plan and a diagnosis that meets the severe mental illness category, than there would not be a limit to the number of sessions. This condition is referred to as “parity” according to legislation that was passed some years ago affecting HMO plans.
• How much does my plan cover for an out-of-network provider? As I mentioned above, sometimes there is an “out-of-network” benefit which would allow for some reimbursement made to you for seeing a provider not in your network.
• What is the covered amount per therapy session? This is your “co-pay” – the amount you would pay per session. Often this is a set number: say $15 a session. I have seen co-pays as low as $5 and as high as $50.
• Is couples counseling covered? In my experience, often benefit plans allow for couples counseling. However, I have seen some cases where this is not the case.
• What about confidentiality? It is my understanding that the same laws that apply to me as a psychotherapist to protect my clients’ personal health care information (known as PHI) also apply to the insurance companies. If you have any questions about that, I would urge you to ask your insurance company.

I hope that the above provides people with useful information when thinking about using insurance to cover psychotherapy costs. I would be glad to answer any other questions to the best of my abilities and based on my experience.