Today, I want to address something that can be rather confusing to navigate when it comes to therapy and insurance. Insurance in the USA can be incredibly confusing to navigate, so hopefully this will help solve some of your questions.
Does insurance cover outpatient therapy/counseling?
Most of the time. More and more, insurance providers are starting to pay for outpatient therapy. For reference, outpatient therapy means meeting with a mental health professional once a week for 50-60 minute sessions. It used to be that insurance providers rarely covered these services, so people were left paying out of pocket. Most insurances nowadays have some sort of mental health coverage, but each plan will vary with the amount covered.
What cost will my specific insurance plan cover?
This is where it can get tricky! Every plan is different. The best way to find this out is by calling your insurance provider or going to their website and entering in your information. Here are some things you will want to be on the look out for and what they mean.
Co-Pay vs. Co-Insurance
A co-pay is a set amount you pay each time you see your therapist. For example, if your co-pay is $25, you will pay $25 at each appointment and then the insurance will pay the remainder. Co-insurance is similar, except the amount you owe is calculated by a percent. For example, if your co-insurance is 20%, you will be responsible for 20% of each session and then your insurance will pay the remainder. For example, if a therapy session is $100, you would be responsible for $20.
Deductible
Your insurance deductible is the amount you must pay before your insurance starts actually paying. For example, if your deductible is $2,000 and you have 20% coinsurance, you’ll pay $2,000 before your insurance starts paying the 80%. Something to note: if you have a co-pay amount, usually you do NOT need to meet your deductible first. This means if your co-pay is $25, you would not need to pay the $2000 first.Confusing I know, but this is something important. In my experience, I see more people having to just pay a co-pay amount rather than meeting their deductible first! Therapy can be affordable and it’s important to know what your plan will cover. I’ve had clients with co-pays as low as $5!
In-Network Provider vs. Out of Network Provider
Every insurance plan has two tiers: in-network and out of network. I won’t get into too many of the details, but you’ll want to find a provider that’s in your network. This is because in-network coverage has a lower deductible and less out of pocket costs. You can absolutely see a provider out of network, but it might end up costing you more. Additionally, out of network providers generally have a higher co-pay fee or deductible when you see them.
Why do some therapists not take my insurance?
Every therapist has a choice on what insurances they will accept. In fact, each therapist goes through a lengthy process called credentialing in order to even be able to accept insurance. It is not automatically assigned, and each insurance is different. Additionally, some insurance companies won’t allow more therapists to join if they feel there is an oversaturation of therapists in the area.
Do therapists offer lower costs options if I can’t afford to pay my deductible or don’t have insurance?
Yes! Many therapists set aside specific spots for sliding scale, where you will pay a lower fee based on income. You can find therapists that accept sliding scale by searching Psychology Today or using the website Open Path. Seeing a therapist that accepts a sliding scale fee is also a great option if you’re having difficulty finding therapist that take your insurance.
Read more about finding a therapists here.
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