Does Insurance Cover Therapy?: Understanding Mental Health Benefits

Health insurance can be a hard topic to understand for most people. Between deductibles, copays, HSAs, and FSAs, it can be really complicated. You might wonder if your health insurance covers therapy and what kinds of mental health services are covered by insurance.

Here, we’ll help you understand some of the most common head-scratchers about health insurance and therapy, and how SonderMind can connect you to licensed therapists who take your insurance where you live. Remember, though, if you have specific questions about your coverage, it is always best to call the number on the back of your health insurance card.

Understanding mental health coverage and benefits 

You might wonder — does insurance cover therapy? The answer is yes. One of the most important things you should know is that mental health services are covered under most insurance policies. This includes therapy and psychiatric care. You may need to pay a copay or coinsurance, just like you would for any other medical service. It's essential to check the specifics of your policy to understand what is covered and what the costs will be. Here are a few terms and concepts about mental health coverage and benefits to help you understand mental health coverage:
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Parity laws ‍

Mental health is physical health. In 2008, Congress passed the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act. This was a huge step toward ending insurance discrimination against people looking for professional help for mental health and substance use disorders. The 2008 act requires insurance companies to cover mental health services just as they would cover physical health conditions. This means that insurers can't charge higher copays, deductibles, or out-of-pocket costs for mental health services compared to medical services. It also means that insurance plans cannot put limits on the number of visits or days of coverage for mental health services.
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Mental health services covered by insurance

‍People go to therapy for many different reasons. It could be to cope with everyday stress or to improve a relationship. It could be to deal with harmful habits or serious mental health conditions. When it comes to therapy, no problem is too big or too small. The Mental Health Parity Act applies to all mental health and substance use disorders covered by a health plan. However, a health insurer can specifically exclude certain diagnoses. These exclusions should be stated in your plan’s description of mental health benefits. Ask your insurance company to find out which mental health services are covered by your insurance plan.
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Network providers

‍Insurance companies have a network of mental health providers. This includes psychiatrists, psychologists, social workers, therapists, and counselors. If you see an out-of-network provider, your insurance may still cover some of the costs, but you will likely have to pay a higher deductible. If you’re looking for mental health treatment and want to use your insurance, SonderMind takes the guesswork out of whether the provider is in your network. We match you with a provider who takes your insurance where you live and meets your preferences.
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Preauthorization requirements‍

Some insurance policies require preauthorization for mental health services. This means that you must get approval from your insurance company before seeing a provider. This can be a lengthy process, so it's essential to plan ahead. Your provider can help you navigate the preauthorization process.  Learn more about referrals and when you might need them. 
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Confidentiality‍

Mental health services are private and confidential. This means that your mental health provider cannot share your information with anyone without your consent. It's important to know that some insurance companies may require access to your mental health records to assess your eligibility for coverage. However, they cannot use the information to deny you coverage.
 

Understanding insurance coverage and benefits terms

‍When it comes to making decisions on the mental health care coverage you have, it helps to know some insurance lingo. Here’s a list of some insurance terms that are not so self-explanatory.

Deductible: A deductible is the amount of money you’re required to pay for medical bills before your insurance kicks in. If your deductible is $2000, your insurance won’t cover any medical costs before you pay $2000 yourself. Some insurance companies will have certain services that they will cover the cost of before you meet your deductible, so call your insurance company if you want to find out if that’s the case for you.

Coinsurance: If your insurance plan has a deductible, you will have a coinsurance. A coinsurance is the percentage of a provider’s bill you pay after you’ve already met your deductible.

Copay: A copayment (copay) is the amount of money that you are required to pay for medical services or medication. Your copay can be different for different services, so be sure to check your insurance card before seeing your provider. This is different from coinsurance because a coinsurance is a percentage of your provider’s bill, while a copay is a flat rate.

Claim: After you receive care from a provider, either you or your provider will submit a request for payment from your health insurance company. The insurance company will then review the request, and pay you or your provider. Sometimes, you will pay the provider first, and after you submit the claim to your insurance and it gets approved, the insurance company will reimburse you.

Out-of-pocket costs: A cost that would be considered out-of-pocket would be any medical costs that are not covered by your insurance. This includes things like coinsurance, copay, and deductibles.

For more on insurance terms, check out our Healthcare Insurance article or the Healthcare.gov insurance glossary.
 

How to find out if your insurance provider covers therapy

While the Mental Health Parity Act applies to all mental health and substance use disorders covered by a health plan, a health insurer can exclude certain diagnoses. Here are some tips on how to find out if your insurance covers mental health care benefits, and which ones:
 

1. Review your insurance policy: Most insurance companies have a summary of benefits that outline what is covered and what is not. Check your policy for the details.
 

2. Call your insurance company: If you're unsure about what's covered in your policy, call your insurance company's customer service department. Ask about your mental health benefits, and ask about deductibles, copayments, and coinsurances. At SonderMind, we make sure that you are connected to a provider who is in your network, and give you information about the provider such as their experience and qualifications so you can have peace of mind that you are meeting with someone who’s right for you.
 

3. Check your network: Each insurance provider has a network of mental health professionals, and if you choose a provider outside their network, you may have to pay more out of pocket. With SonderMind, it’s easy to find a licensed provider who is in your network. Just answer a few questions and we’ll connect you to licensed providers who accept your insurance. You don’t have to search through directories or join a waitlist. 
 

4. Check your EAP. An Employee Assistance Program (EAP) is a benefit program that can assist employees with issues that affect their health, mental, and emotional well-being. Your EAP is a voluntary program that will offer you free assessments, counseling, referrals, and more. In some cases, your EAP benefits reset each year, so it’s important to look into your EAP specifically. Learn how to use an EAP or insurance to cover the cost of therapy.
 

5. If you have a therapist in mind, SonderMind can help: If you have a specific mental health professional in mind, SonderMind does all the heavy lifting for you. We’ll let you know if the mental health professional is in your network, and if they’re not, we’ll give you information on other therapists who accept your insurance.  
 

If you don't have insurance, try contacting local mental health resources in your area. Many communities have mental health agencies or clinics that provide mental health services at a discounted rate based on income. Additionally, some organizations provide mental health services for free. SonderMind offers competitive self-pay options to help you get the mental health care you’re looking for.
 

SonderMind makes it easy 

SonderMind can help take the hassle out of connecting to a therapist or mental health professional in your area who accepts your insurance. SonderMind therapists are in-network with most major insurance plans in many states, which means you get direct access to mental health professionals, without having to dig through an outdated directory or get on a waitlist.

Who we partner with

• Aetna
• Ascension Personalized Care
• Blue Cross Blue Shield
• CareSource
• Cigna
• Kaiser Permanente
• Medical Mutual
• Medicare
• Oscar
• UnitedHealthcare

Where we are

• Arizona
• Colorado
• District of Columbia
• Georgia
• Indiana
• Kentucky
• Maine
• Maryland
• Massachusetts
• Missouri
• Nebraska
• New Hampshire
• Ohio
• Texas
• Vermont
• Virginia

‍We’re here to answer questions and connect you with a therapist

At SonderMind, finding a therapist is easy. We do the work for you — just tell us a bit about what you’re looking for in a therapist, where you’re located, and who you have for insurance. Then, we’ll connect you with a licensed therapist who meets your needs and accepts your insurance. If your insurance doesn’t cover therapy, SonderMind offers self-pay options. Get started connecting to a SonderMind therapist here. 

If you’re not quite ready but have questions, we can help you get the answers. Just call us at (844) 257-0989, Monday - Friday, 7 AM - 6 PM MST. Or, reach out to us at [email protected]. We can help you figure out the next best steps to get you the mental health support you’re looking for.