Does Insurance Cover Therapy

1
Does Insurance Cover Therapy? Daniel Belcher,
CEO, Lifebulb Feb 10, 2023
Mental health is a significant (and
often-overlooked) aspect of overall well-being.
Yet, many of us may struggle to access the
treatment we need due to financial constraints,
geography, or lack of understanding coverage for
mental healthcare, therapy, or counseling by our
insurance plans. So let's tackle that third
aspect Is treatment for mental healthcare,
therapy, and counseling covered by insurance?
How does mental health insurance coverage
works? What is insurance for mental
health? Fortunately, most insurance plans cover
treatment for mental health conditions, but it's
essential to understand what's covered and
not. As someone who has struggled with mental
health issues, I understand the importance of
accessible treatment. I also know how confusing
and overwhelming it can be to navigate the
insurance system and understand coverage. Copays,
deductibles, out-of-pocket fees, in-
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• network, out-of-network? The jargon is nearly
  endless so it isn't difficult to see why
  understanding the ins and out's of insurance
  coverage can be daunting.
• I may not dive into definitions here, but I want
  to provide an overview of what types of insurance
  cover mental health treatment and what to expect
  when seeking counseling or therapy for your
  mental health needs or goals.
• First and foremost, it's important to understand
  the types of insurance that may cover mental
  health treatment. Some of the most common ones
  include
• Private health insurance Many private health
  insurance plans include coverage for mental
  health treatment. This can include individual and
  family plans, as well as group plans offered
  through an employer. Some plans may require a
  primary care physician referral before they
  cover mental health treatment.
• Medicaid and Medicare Both Medicaid and Medicare
  offer coverage for mental health treatment for
  eligible individuals. This can include inpatient
  and outpatient care, as well as prescription
  medications.
• Military and Veterans Affairs (VA) benefits
  Active-duty service members and veterans may be
  eligible for mental health coverage through the
  Department of Defense or the VA.
• It's important to note that not all insurance
  plans will cover all types of mental health
  treatment. Some plans may only cover certain
  types of treatment, such as inpatient care or
  prescription medications. Others may limit the
  number of visits or the amount of coverage
  available.
• It's becoming increasingly difficult to find a
  plan that doesn't provide mental healthcare
  coverage and it's getting better every day!
• To find out what's covered under your insurance
  plan, youll need to review your plan's summary
  of benefits. And often, the best way to get a
  complete understanding is to contact your
  insurance provider directly. They'll be able to
  fill you in on the specific types of mental
  health treatment covered, as well as any limits
  or exclusions that apply to your particular plan.
• It's also worth noting that some insurance plans
  may require you to see a provider within their
  network to receive coverage. If you are seeing a
  therapist or counselor who is not in your
  insurance plan's network, you may have to pay
  more out of pocket for your treatment. Or, the
  provider may provide you a superbill to submit to
  your insurance for reimbursement.
• What is a superbill exactly?
• A superbill is a document provided by a
  healthcare provider, such as a therapist or
  psychologist, that contains detailed information
  about the services that were provided during a
  visit. It is usually used for patients who are
  seeking reimbursement from their insurance
  company for out- of-network or out-of-pocket
  expenses.
• A superbill typically includes information such
  as the date of service, the type of service
  provided, the diagnosis, and the billing codes.
  It also includes the provider's name, address,
  and Tax ID number.
• The superbill is not an invoice, it is a document
  that the healthcare provider generates and
  provides to the patient so they can submit it to
  their insurance company for reimbursement. The
  patient will then be responsible for submitting
  the superbill to their insurance company along
  with any other required documentation, such as a
  claim form.
• It's important to note that not all insurance
  companies accept superbills and some may require
  additional information or forms to be submitted
  with the superbill. It's important to check with
  your insurance company to understand their
  specific requirements and procedures for
  submitting a superbill for reimbursement.

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• It's also important to note that some states laws
  or regulations may apply to superbills, like
  requiring specific information or format.
• Basically, a superbill may allow a person to get
  reimbursement from their insurance company if
  they are seeing an out of network counselor or
  therapist. youll be responsible for submitting
  the superbill to your insurance company along
  with any other required documentation. It's
  important to check with your insurance company to
  understand their specific requirements and
  procedures for submitting a superbill for
  reimbursement, as they may not always reimburse!
• Outside of superbills, another aspect to consider
  about general mental health insurance coverage
  is that some insurance plans may require
  pre-authorization before treatment can begin
  (although this is becoming rarer and rarer). Some
  may require you to try a less expensive
  treatment before they approve a more expensive
  one (again, not very common when it comes to
  mental healthcare but worth noting!).
• What happens if insurance plan doesn't cover the
  treatment you need?
• There are a few options to consider
• Out-of-pocket If your insurance plan doesn't
  cover the treatment you need, you may have to
  pay out of pocket. This can be expensive, but
  some providers may offer sliding scale fees based
  on income or offer financing options.
• Community resources Many communities have free
  or low-cost mental health clinics or support
  groups. These resources can provide valuable
  support and treatment, even if you don't have
  insurance.
• Employee assistance programs (EAPs) Some
  employers offer EAPs, which provide employees
  with free or low-cost mental health services.
  Though, be aware it is a bit more difficult to
  find therapists, especially in outpatient
  settings that accept EAP benefits.
• What about Outpatient Mental Health Therapy
  coverage, specifically?
• Several factors are worth considering when
  considering insurance coverage for mental health
  therapy in an outpatient setting. Let's run
  through 8 of them worth being aware of
• Network Providers Many insurance plans have a
  network of providers they have contracted to
  provide services at a discounted rate. It's
  essential to check if the therapist or clinic you
  are considering is in-network with your
  insurance plan, as out-of-network providers may
  not be covered or may require a higher
  out-of-pocket cost.
• Copayments and deductibles Some insurance plans
  require copayments for each therapy session, and
  others require individuals to meet a specific
  deductible before coverage kicks in.
  Understanding these costs and how they will
  impact your overall expenses is important.
• Frequency and duration of therapy Insurance
  plans may limit the number of therapy sessions
  they will cover in a given year or limit the
  duration of therapy. Understanding these limits
  and how they may impact your treatment plan is
  important.
• Out-of-network coverage If you choose to see a
  therapist, not in your insurance network, you
  may still be covered, but at a lower rate. It's
  important to check with your insurance provider
  to understand out-of-network coverage and how it
  will affect your costs.
• Pre-authorization Some insurance plans require
  pre-authorization before treatment can begin.
  You will need to get approval from your insurance
  provider before starting therapy. It's important
  to check with your insurance provider to
  understand the process and any requirements for
  pre-authorization.
• Behavioral Health Integration Many insurance
  plans now offer Behavioral Health Integration
  (BHI), where primary care doctors and mental
  health providers work together to coordinate care

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• for the patient. This can be an excellent option
  for those with physical and psychological health
  concerns.
• Type of therapy Different types of treatment,
  such as talk therapy, art therapy, and music
  therapy, may be covered differently by insurance
  plans. It's a good idea to check with your
  insurance provider to understand what types of
  therapy are covered and how they will be paid
  for.
• Medication coverage Some insurance plans may
  also cover medication prescribed by a mental
  health provider. It's important to check with
  your insurance provider to understand what
  prescriptions are covered and how they will be
  paid for.
• It's important to note that insurance coverage
  for mental health counseling can be complex and
  may change over time. It's important to
  periodically check with your insurance provider
  to understand any changes in coverage or to have
  a clear understanding of your coverage.
• It's also worth mentioning that some states have
  laws that mandate a certain level of coverage
  for mental health by insurance companies, so
  check your state's laws and regulations to ensure
  you are getting the coverage you are entitled
  to.
• That list may be a bit overwhelming at first
  but here's a quick summary to pull it together
• If you're unsure about your coverage specifics,
  contact your insurance company directly. (their
  members' information contact number is usually
  listed on your insurance card!)
• If you're unsure about certain costs for a
  specific provider, therapist, or counselor you
  want to see call them! Usually, they can help
  explain the process of verifying your information
  and ensure your experience is seamless as you
  begin your therapy journey.

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Conclusion Just remember, mental healthcare is
huge when it comes to your overall well-being,
and many insurance plans cover treatment for
mental health for various needs, goals, or
conditions. And don't forget, if your insurance
plan doesn't cover the treatment you need, other
options exist,
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such as out-of-pocket payments, community
resources, or employee assistance programs. It's
also important to remember that seeking help for
mental health issues is never a sign of
weakness, and options are always available to
help you get the treatment you need! If you've
read this far and are seeking outpatient mental
healthcare, reach out to us today! We're excited
to help you accomplish your therapy goals!
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