Although psychotherapy is frequently a significant component of an overall strategy for treating mental illness, the extent to which various insurance policies cover treatments related to mental health varies greatly. Policies purchased outside of the Marketplace are not required to comply with the requirements of the Affordable Care Act (ACA), despite the fact that the majority of plans now include medically essential therapy.

Plans that comply with the Affordable Care Act are required to provide mental and behavioral health care as part of their essential health coverage. However, even if your insurance does cover certain services, there may be some restrictions that prohibit you from receiving as much assistance as you require.

It is not always easy to determine whether or not your insurance company will pay for treatment. This is especially true if you are already feeling worried or nervous at the time that you are researching your coverage possibilities. To be of assistance, the following is additional information on the ways in which therapy may be covered by health insurance.

How much does it cost to go to therapy?

Even though it's not inexpensive, talking things out in therapy is sometimes the most cost-effective way to manage mental health problems. The price of therapy can be affected by a variety of factors, including the following:

The kind of service provider you see, in addition to their credentials.

What kind of psychotherapy are you looking for?

The terms of your insurance policy.

Your current abode

How long does each session typically go on for?

One session of treatment will normally cost at least one hundred dollars, and the majority of therapists charge two hundred dollars or more for each session. There is also the possibility of finding therapists that operate on a sliding scale, which modifies the amount you pay based on the annual income of your household.

Billing Procedures for Psychotherapy

If your therapist takes your insurance, they will bill your insurance company using specific CPT codes related to mental health if they accept it. These include information regarding the sort of therapy you had and the length of time you were treated for, so the insurance company is aware of the services that were provided.

The following are some examples of frequent codes:

90832 Psychotherapy, 30 minutes

90837 Psychotherapy, 60 minutes 

90845 Psychoanalysis

90846 Family psychotherapy without the patient 

90847 Family psychotherapy with the patient 

90853 Group therapy 

Before your insurance coverage begins to take effect, you are going to be responsible for paying any copays, coinsurance, or deductibles that may apply.

Insurance Coverage for Counseling and Psychotherapy

Any insurance company that provides mental health benefits, such as those offered by the Affordable Care Act, is prohibited under the Mental Health Parity and Addiction Equity Act from setting restrictions that are more stringent than those for its medical and surgical service. Therefore, if your insurance provider provides coverage for mental health issues, it is prohibited from setting arbitrary price restrictions on the amount of money you may spend on counseling.

However, insurance companies will only pay for therapies that are seen as having a "medically required" purpose, and not all forms of therapy fall into this category. Even if your insurance plan includes mental health benefits, there is a good chance that your insurance company will not pay the cost of your treatment sessions if you do not have a diagnosis of a mental health condition.

Step therapy is the process that is followed when an insurance provider mandates that a patient try out more affordable treatment choices before moving on to more expensive ones. This indicates that you might not be eligible for the specific treatment that your therapist recommends for you until you have tried a few different possibilities first.

Insurance Coverage For Therapy Has Its Limits

In the past, insurance companies commonly capped the amount of mental health benefits you could receive each year or severely limited your coverage in other ways. This was made possible by the Mental Health Parity and Addiction Equity Act. Any limitations that exist now must be no more stringent than those imposed on your physical health.

Non-ACA compliance plans sold outside the Marketplace are not obliged to include mental health coverage, even if ACA-compliant plans, Medicare, and Medicaid must. So, check with your insurance to see if there are any restrictions. The brief plan description in your policy is an excellent place to start looking for limits.

How to Verify the Coverage of Your Insurance Plan

If you want to utilize your insurance benefits to pay for therapy sessions, be sure they're covered first. Start by looking through your plan documentation to discover what mental health therapies are available.

Then you may phone your insurance company and ask clarifying questions to assist you figure out what is and isn't covered. Here are some questions you might want to consider:

Is there anything in my plan that covers mental health?

What is the amount of my deductible? How much of this total have I met?

How many treatment sessions are covered by my coverage per year?

Is there a limit to the length of each session?

Which therapists are included in the network?

How much will treatment sessions cost me out of pocket?

Do I have to pay more for a therapist who isn't in my network?

Is it possible to file a reimbursement claim from an out-of-network provider?

Is a recommendation from my primary care physician required?

Is there a list of CPT codes that my provider must use in order to be approved?

The process of gathering this information will take some time, but it is crucial. It will assist you understand what to expect from your insurance coverage.

What to Do If You Need Assistance Paying Your Therapy Bills

Insurance isn't the only option to reduce your therapy out-of-pocket costs. If you need assistance paying for therapy, consider the following options:

Look for therapists that charge on a sliding scale.

Consider telehealth, which is sometimes less expensive and can be completed from the convenience of your own home.

Instead of going to a private practice, go to a nationally supported health center.

Look into whether a nearby institution provides low-cost treatment provided by psychology students.

Call around to other therapists to see if they provide low-cost sessions or can refer you to one who does.

Check to see whether group therapy is a good fit for you. It is frequently less expensive.

On a budget, there are several options for supporting your mental health needs. Don't give up until you've found what you're looking for.