Learning how to use insurance for therapy is easy once you understand your insurance benefits. We are here to simplify the process and give you word-for-word questions to ask your insurance company to understand how they cover therapy sessions.
Oftentimes, the cost of therapy can act as a barrier to seeking care. However, there are many ways to reduce your out-of-pocket costs when it comes to therapy. One of these ways is to use your insurance benefits.
Ultimately, therapy is an investment in you, or your child and family’s, mental and emotional wellbeing, which is something that is difficult to put a price tag on. Remind yourself that you’re worth the investment and you deserve to live your best life.
Using Insurance for Therapy
The way your insurance covers care depends on whether you choose an in-network or out-of-network provider.
An in-network provider is a therapist your insurance company contracts with to provide services to their members. They provide care at an agreed-upon rate, and you are only responsible for your copay at the time of service. Your insurance will pay your therapist directly for their services.
On the other hand, an out-of-network (or self-pay) provider is a therapist who is either outside of your insurance network or does not accept insurance. You are responsible for paying them their full fee at the time of service. Many insurance companies offer some type of out-of-network coverage to help with costs if you choose to seek care outside of your insurance network.
How to obtain out-of-network benefits:
- At the time of service, pay for therapy out-of-pocket and request a “superbill”. A superbill is the documentation of the session, which includes the counselor’s license number, NPI number, billing code, and diagnosis code.
- Mail this documentation to the address provided by your insurer or upload it to your insurer’s member portal. Reimbursement often requires you to follow up, so make sure to keep a copy of the superbill for yourself.
- Expect to wait. A standard length of waiting time is 30 days, sometimes longer. In the meantime, keep track of sessions and charges that are accruing.
- When you receive payment, compare your records. There is often a ‘window of appeals’ if something is incorrect.
Benefits of Seeing an Out-of-Network Provider
One of the most important factors when finding a therapist is the fit. You are more likely to reach your goals and improve your therapeutic outcomes when you work with a therapist who is a good fit. With that in mind, seeing an out-of-network provider means:
- More choices: You are not bound to the list of therapists from your insurance company. You can explore all of your options and find a therapist who works for you.
- Greater availability: In-network therapists are often fully booked or can have waiting lists that are over a month long. Out-of-network providers have smaller client loads and generally have more availability and offer greater flexibility with scheduling as well. Some therapists also allow you to contact them in-between sessions as needed. When it comes to mental health care, time is of the essence. Putting off seeking care may have a negative impact on your mental state.
- Privacy: Going to an out-of-network provider guarantees your privacy. You can be assured no other party (such as your insurer) has access to your mental health information, such as your diagnosis. Insurance providers require a diagnosis in order for you to receive care. If you are not comfortable with a diagnosis going on your record, an out-of-network provider may be the better choice.
- Comparable costs: What many people don’t realize is that when your insurance offers out-of-network reimbursement, the cost can be comparable to an in-network provider. Speak with your insurance company to get all of the details. You may find that the difference in costs is small or negligible.
Understanding How to Use Insurance For Therapy
Understanding your insurance benefits can be confusing if you aren’t familiar with the terminology they use. Sometimes it feels as though insurance companies make their lingo super confusing on purpose! Here are a few common insurance terms and their definitions (in easy-to-understand language):
- Deductible: Your deductible is the amount you must pay before your insurance coverage starts to kick in. Your in-network and out-of-network deductible may be different.
- Copay: This is the amount you are responsible for at the time of service. This cost averages between $20-$50.
- Coinsurance: You may either be required to pay a copay or you may be responsible for a percentage of the costs, also known as coinsurance. If your coinsurance is 30%, you are responsible for 30% of the cost of service.
- Out-of-Pocket Maximum: This is the maximum amount of money you will pay in a calendar year for healthcare services. Your insurance company will cover 100% of costs above this amount.
Questions to Ask Your Insurance Company
The easiest way to learn about your mental health coverage is by calling your insurance company. There is usually a customer service number located on the back of your insurance card. You can also log onto your insurance company’s member portal and chat with a representative.
Here are a few questions that you can ask to help you understand how to use insurance for therapy:
- Do I have coverage for mental health services, including individual therapy?
- If I choose to see an in-network provider…
- Do I have to meet a deductible before my coverage kicks in? If so, how much of my deductible is remaining?
- What is my out-of-pocket expense per session?
- Do you offer out-of-network reimbursement?
- What is my deductible and how much of my deductible is remaining?
- How much will you reimburse me for each session?
- What is the process of receiving out-of-network reimbursement?
- Is there an annual session limit for therapy?
How to Reduce Your Out-of-Pocket Therapy Costs
- Health Savings Account (HSA)/ Flexible Spending Account (FSA) – Consider putting money away at the beginning of the year into your health savings account or flexible spending account. This is tax-free money that you can use toward mental health services. When allocating funds into your account, be sure to calculate approximately how much you plan to spend on healthcare services during the calendar year since FSAs are “use it or lose it” and HSAs have a rollover cap of $3,650 from year-to-year.
- Employee Assistance Programs (EAP) – Many companies offer an employee assistance program for mental health services. Consider speaking to HR to learn more about what EAP benefits you may have. Some EAPs cover the first few therapy sessions.
- Sliding scale – Some therapists have slots for sliding scale patients who cannot afford their full fee. These therapists charge patients based on their income and what they can contribute. You can usually find whether or not a therapist offers this option on their website or by calling them directly.
- Community-based services – If you are looking for free or reduced-cost therapy, you may want to look into community-based services offered by your county or state.
We are Here to Help
Insurance can make the process of seeking help more challenging than necessary. We want to support you and answer any questions you may have about the costs associated with therapy.
Give our care coordinator a call today. We can help you find a counselor that is a good fit for you – therapeutically and financially. With convenient locations in Georgetown and Liberty Hill, we can’t wait to serve you.
Rooting for you,
-Jenna
Jenna Fleming, LPC, NCC, is a Georgetown, TX therapist. She is also the owner at Georgetown and Liberty Hill Child & Family Counseling, where it is their mission to help people thrive through Christ-centered counseling.
