Does Health Insurance Cover Therapy? How to Navigate Your Insurance for Mental Health Care | Teen Vogue

There’s no shame in needing help coping with your mental health, and there’s no shame in not knowing how to start the process of finding it. Figuring out how to access therapy isn’t always easy, and can be confusing even for the most experienced consumers. But, understanding what you’re up against is the first step. If you have health insurance, you’re one step closer to finding affordable therapy, but first you have to learn how to use your insurance and understand your benefits (if you don’t have insurance, don’t worry. You can still find affordable therapy — more resources on that here).

“Insurance is complicated for most adults who have used their health insurance in the past,” New York therapist Dhvani Patel Lindsey, LMFT said. “So if you are confused or worried about how to navigate it, you’re not alone. It does take some time to educate yourself, but the information is out there.”

To help with the process of booking your first therapy session, Teen Vogue has put together a guide of some of the most common questions, terms, and concerns you might run into when you start trying to figure out if your insurance plan can help with the cost of therapy.

Here’s what you need to know about accessing your health insurance benefits.

Does health insurance cover therapy?

It certainly can! All health insurance plans are different, so it depends on what specific plan you have. Whether your therapy will be covered also depends on what therapist you choose. Some therapists only take specific insurance, while some don’t accept insurance at all. That’s why all of this can be so confusing — there are many variables that can impact your situation, and that can feel overwhelming in and of itself. But by asking the right questions, you can totally figure this out. So, let’s get into the kinds of questions you can ask and who to ask them of.

The easiest way to find out what your plan covers is by finding a schedule of benefits

A schedule of benefits is a document that outlines the costs associated with all of the health care services that are covered by your plan.“It is like a spreadsheet of your costs for different types of services, they’ll have what your mental health care costs,” Lindsey said. “Before you start your search for your therapist, you want a realistic sense of what the cost might be.”

You can find your schedule of benefits online by looking up your health insurance provider and the type of plan you have — this information can be found on your health insurance card. Once you’ve located the most up-to-date version of your schedule of benefits, you can search for mental health benefits and see what the cost may be.

Understanding your schedule of benefits

There are a couple of important terms that are key to understanding your schedule of benefits and how much therapy may cost for you.

If your health insurance does not cover mental health benefits until your deductible has been met, you may want to look into alternative therapy options. Some therapists will offer a sliding scale payment option based on how much a client can afford. If you are interested in these options, you can ask potential therapists if they have a low fee or no-fee services. 

If you have questions about whether your deductible has been met, you can call your health insurance provider using the number on your health insurance card. Asking the following questions may help you gain some more clarity on your plan’s benefits:

One of the most important things when looking for a therapist is how you feel about them. “Research shows that the most important factor in therapeutic success is the client-therapist fit.” Lindsey said.

During your phone consultation with a potential therapist, leave some room at the end of the call to talk through some of their payment options. Here’s a list of questions you should ask your therapist to understand how their practice deals with billing:

You can call your health insurance provider and request an explanation of benefits to be sent directly to you, instead of your policyholder. An explanation of benefits is a statement that describes the cost of the care you received and how much your health insurance covered, as well as the medical expenses you would be responsible for. Under the Health Insurance Portability and Accountability Act (HIPAA), health insurance providers are required to protect patient confidentiality, and some states have taken further measures to ensure that people on their parents’ health insurance would be able to protect this right. Still, it might depend on where you live and your specific insurance company, so it’s possible your insurance won’t comply with your request.