Will My Insurance Pay for Therapy?

Before paying for a mental health service, find out if your insurance provider will cover your mental healthcare needs – including online therapy.

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For many people, talk therapy is an invaluable personal investment in self-awareness and growth — but it can come at a steep price. On average, data shows a single talk therapy session costs between $100 and $200 when you’re paying out of pocket. The good news is, if you have insurance, the fee can be as low as $20 to $50 per session, so many people try to find a mental health professional who is in-network (meaning they take your insurance). 

With that in mind, you may be wondering if your health insurance plan covers your therapy needs. Below, we review what therapeutic services insurance will typically cover, as well as how to access in-network therapy services like Charlie Health’s virtual Intensive Outpatient Program (IOP). 

Does insurance cover therapy?

If you’ve ever wondered how you’re going to pay for therapy, you’re not alone. Therapy cost is often viewed as a leading barrier to mental and behavioral healthcare. The good news is that there are laws and regulations designed to make mental health services more accessible and affordable. You’ve probably heard of one: the Affordable Care Act (ACA), also known as Obamacare. Under the ACA, mental and behavioral health services are considered essential health benefits — meaning insurance must cover them. What’s more, the ACA states that people cannot be denied therapy coverage or charged higher fees for having an existing mental illness or substance use disorder.

Another law to know is the Mental Health Parity and Addiction Equity Act (MHPAEA). Passed in 2008, the MHPAEA requires health insurance plans to cover mental health conditions, including substance use disorders, in the same way they cover physical health conditions. This means mental health coverage cannot be more restrictive than coverage for issues such as allergies, chronic disease, and the common cold.

Ask these questions to see if insurance will pay for your therapy

Although there are laws requiring insurers to cover mental health services, there are other factors to consider when trying to understand if your therapy will be covered. Here are questions to ask in order to determine if your insurance will cover your therapy needs. 

1. Is your mental health provider in-network? 

Therapy may be less expensive if you work with a mental health provider who is in-network with your insurance plan. This means that your provider, such as a therapist, has contracted with your insurance plan to provide services at set rates. If you use an out-of-network provider, services may be more expensive or not covered at all. This is known as private pay. 

2. What’s your deductible and copay?

Most people have a deductible, meaning they’ll pay out-of-pocket for services until they spend a set amount of money. You may also have a copay, which is a fixed cost for specific services like therapy appointments and prescription medications.

3. Does your insurance plan have limitations?

Some insurance plans have restrictions on the number of therapy sessions a person is eligible for each year. Depending on your therapeutic needs, this is important to confirm before starting therapy. 

4. Is this a medically necessary therapy service?

“Insurance companies make the decision on therapy coverage based on their internal medical necessity criteria,” says Kathleen Douglass, MA, LCPC, a Charlie Health Clinical Supervisor. “That means if the company does not feel that you need the services that you want to have, they have the right to cut the therapy coverage for the services, leaving the client responsible for any further services from the cut date of the insurance policy.”  

What type of therapy is usually covered by insurance?

“Most insurances now cover outpatient therapy, which includes individual, family, and group therapy with either a zero co-pay or a nominal co-pay, as a result of the Mental Health Parity Act,” says Douglass. “In addition, intensive outpatient programs, partial hospitalization programs, and inpatient are typically covered on some level as well.”

Health insurance coverage may vary by insurance plan but typically includes services like:

Mental health therapy

Talk therapy refers to individual, group, and family counseling services. Importantly, “most insurances cover these services in person and in telehealth,” explains Douglass. 

Medications 

Prescription medications for mental health conditions include antidepressants, antipsychotics, mood stabilizers, stimulants, and anti-anxiety medications. Check to see if your insurance plan covers brand-name medications or generics.

Substance use treatment

Treating substance use often includes medication, therapy, and sometimes even inpatient rehabilitation. Notably, research shows that online therapy and treatment programs are an effective option for substance use disorders and addiction.

Emergency care

Insurance plans typically include psychiatric emergency services, meaning situations that require immediate intervention and stabilization. For example, suicidal thoughts, psychosis, and violent behavior. 

How do I know if my therapist is in-network? 

Figuring out your mental health coverage can be incredibly overwhelming, especially when you’re already struggling with a mental health concern or difficult life circumstances. Here’s how to check if your provider or mental health service is in-network — and how to find one who is. 

1. Review your insurance plan

Visit your insurer’s website to search for providers who are available in your area or for virtual services. If you’re still not sure who or what is covered by your insurance plan, you can call their customer service support line. This is a chance to ask questions about your policy and providers, such as:

• Is a certain provider in-network?
• How can I search for providers that are in-network? 
• Do you cover all types of therapy, including virtual visits and family therapy?

2. Confirm details with the provider

Most insurance plans have an online therapy directory where you can search for providers by name, location, and specialty. Once you find a provider, it’s best practice to confirm that they’re accepting new clients and still take your insurance.

“It is always important to have any provider verify that your policy is accepted because there are lots of nuances to insurance policies, and each one has different levels of coverage and networks,” explains Douglass. 

Does Charlie Health accept insurance?

In short — yes. Charlie Health is committed to making mental healthcare both accessible and affordable for those who need it. The virtual Intensive Outpatient Program (IOP) is in-network with most major insurance plans, including TriCare and Medicaid (in select states). Charlie Health also accepts some out-of-network insurance plans and can work with each person’s policy to maximize their benefits. 

“We accept many insurance policies that come from commercial policies, policies in the health insurance marketplace, and through the Medicaid programs,” says Douglass. “Our goal is to be as accessible as possible, and we are always working on expanding our partnerships with payer sources.”

How Charlie Health can help 

If you’re struggling to find affordable mental health treatment, Charlie Health is here to help. Our virtual Intensive Outpatient Program (IOP) is a mental health service that provides more than once-weekly mental health treatment for people dealing with serious conditions — and we’re in-network with
most major health insurance providers, including commercial plans and Medicaid in eligible states. 
To start treatment with Charlie Health, simply share your insurance information with the Admissions Team. From there, the Benefits Team will contact your insurance company to understand which Charlie Health services will be covered. With this kind of support, it’s possible to find mental healthcare that meets your needs. Fill out the form below or give us a call today to start treatment.