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 “Behavioral Health” phone number or website. Call or visit this to get details about copays, deductibles, in-network vs. out-of-network coverage, and whether you need preauthorization.
In-network providers have contracts with your insurer, which typically means you only pay a fixed copay. Out-of-network providers aren't contracted, so you'll usually pay upfront and get reimbursed a percentage based on your plan—often after meeting a higher deductible.
Some managed care plans require preauthorization, meaning your insurer must approve therapy sessions before you attend—if you skip this step, your plan may not pay.
Yes. Insurance rules and benefit structures vary widely across companies and plans, which means details like copays, deductibles, and network levels differ. It’s important to understand your own plan to avoid surprises.
