Many patients want to use their health insurance to pay for therapy. Usually on the back of your insurance ID card there will be a phone number for ‘Behavioral health’ or ‘Mental health’ or a similar term. Sometimes there will also be a website address. Call the number and first find out exactly what your mental health benefits are under your plan. Ask questions about anything you don’t understand.
Many plans have their own network of doctors and psycho- therapists. These are called ‘in-network providers’. What this usually means is that you can see these people for just the price of your copay, and the doctor or therapist will send a bill to your insurance company for the rest of the fee, which you don’t have to worry about. Many plans also have an ‘out-of-network benefit’. What this usually means is that you can see doctors or therapists who are not in-network and get some reimbursement from your insurance company, usually a percentage of the fee up to some limit. Often you will have to pay the doctor or therapist up front in these cases, and then send the bill or receipt for the services to your insurer. Your insurer will then send you a check for what they owe to you. You should know, however, that out-of-network benefits often have high deductibles (a deductible is the amount you will have to pay in full before your out-of-network benefits start). In addition, out-of-network fees are generally more expensive than in-network fees, so appointments with out-of-network providers are likely to cost clients more money than in-network providers.
Some insurance plans are ‘managed care’ plans, and these may require preauthorization. This means that the insurance company must approve your visits to a doctor or therapist before you go, or else they won’t pay. See if your plan requires this, and if so, how to get preauthorization.
You may note that in almost every sentence I have had to use the word ‘usually’. This is because there are many insurance companies, and many plans within each company. Each company makes it own rules for its own plans, and has its own terminology. It may seem tedious, but a very good idea to know your benefits as well as possible before searching for a doctor or therapist.
Check the back of your insurance ID card for a telephone number or website for behavioral health or mental health services. Contact your insurer to ask what mental health benefits your plan provides, including coverage for psychotherapy, copayments, deductibles, coinsurance, in-network and out-of-network benefits, and any preauthorization requirements or limits on services. Insurance benefits vary by plan, so confirm the details directly with your insurer before beginning treatment.
In-network providers have an agreement with your insurance company to provide services under the plan's contracted rates and terms. Out-of-network providers do not have the same contractual arrangement. Depending on your plan, you may have to pay an out-of-network provider upfront and submit a claim for possible reimbursement. Out-of-network benefits may also involve a separate deductible, coinsurance, or other limitations. Check your plan to understand what you would pay under either arrangement.
Preauthorization is approval from your insurance company that may be required before certain services or treatment sessions are covered. Some plans require preauthorization for mental health treatment, while others do not. Ask your insurer whether approval is necessary, who must request it, and whether it applies to a particular service, provider, or number of sessions. Failing to obtain required authorization may affect coverage, so confirm the requirements before treatment begins.
Insurance companies offer different plans, and benefits can vary even among plans issued by the same insurer. Copayments, deductibles, provider networks, authorization requirements, and reimbursement policies may all differ. General information can help you understand insurance terminology, but it cannot establish exactly what your plan will cover. Contact your insurer to confirm your benefits, and keep a record of the information provided, including the date of the conversation and any reference number.
These terms describe different ways you may be responsible for paying for health care. A copayment is a fixed amount you pay for a covered service. A deductible is the amount you must pay for certain covered services before your plan begins paying according to its benefits. Coinsurance is the percentage of the allowed cost you pay for a covered service after any applicable deductible. Your plan documents explain which amounts apply to mental health services and how they affect your out-of-pocket costs.
No. Coverage depends on your insurance plan, the type of treatment, the provider's network status, and any applicable medical-necessity or authorization requirements. Plans may have different coverage rules for routine outpatient psychotherapy, psychiatric services, intensive outpatient programs, day treatment, or inpatient care. Before beginning treatment, confirm that the service and provider are covered under your specific plan. The Types of Mental Health Treatment page explains common treatment approaches and levels of care.
Start by reviewing the explanation of benefits or denial notice to understand why the claim was denied. Contact your insurer to ask for clarification and find out whether additional information, corrected claim details, or an appeal is needed. You can also contact the provider's billing office to determine whether any information needs to be corrected or resubmitted. If you disagree with the decision, ask your insurer about its appeal process and deadlines. Follow the instructions provided by your plan.
Depending on your circumstances and location, lower-cost options may include therapists who offer sliding-scale fees, community mental health centers, and training clinics associated with graduate psychology or counseling programs. Some training clinics offer services provided by clinicians working under supervision. You can also ask providers about payment arrangements or reduced fees. Availability, eligibility, and costs vary. The If You Lack Health Insurance article discusses additional options for obtaining affordable mental health care.
If you are considering therapy at ITI-NJ, review the Fees & Insurance page for information about insurance plans accepted in-network and the process for verifying benefits. Not every ITI-NJ therapist participates in every listed insurance plan, so confirm that the specific clinician is in-network before beginning treatment. If you have questions about coverage or fees, contact ITI-NJ's intake department for guidance.
Understanding insurance is one part of finding appropriate mental health care. It can also help to learn about different types of treatment, the roles and qualifications of mental health professionals, and how to choose a provider. ITI-NJ's How to Find Professional Help overview brings together information about these topics, including guidance on treatment options, professional credentials, insurance, and finding care when you do not have insurance.
In our work with children, teens, parents, and adults, we strive to meet the needs that everyone has for validation and support while helping them to expand their self-awareness and the range of skills they employ to work out solutions to the problems they face in life. Our mission at ITI-NJ is to improve psychotherapy outcomes for all clients and families in the communities we serve and to provide excellent, quality care with compassion and respect for all we serve.
Visit our Therapy Services Overview page for more information.
