Using Your Health Insurance for Mental Health Care
How do I assess my insurance coverage for counseling and mental health support?
You will find a member phone number most often located on the back of your insurance card. When you call this number, ask about your behavioral health coverage. Counseling and psychiatry are covered under “behavioral health” which is separate from medical health benefits. Each has its own coverage, reimbursement, and procedures.
You can use all of the remaining questions on this website as a guide for what questions to go over when you call your insurance company’s customer service. Ask for (1) information about your out of pocket costs (these are the costs that you are responsible to pay) which includes deductibles and co-insurance/copays, (2) whether there are session limits, and (3) whether referrals from a doctor are required. You also can receive guidance in finding providers that are paneled in your insurance network and learn about your out-of-network coverage.
What is my deductible for behavioral health?
Deductible: this is the amount of money that you are responsible for paying in full before your coverage begins. Deductibles can vary from several hundred dollars to a few thousand dollars. You will pay the full cost of services until the deductible amount is met. After you meet the deductible, your insurance will cover some amount of the cost and your out of pocket cost is either a copay or co insurance.
What is my co-pay or co-insurance?
A co-pay is a flat fee per visit, and co-insurance is a percentage of the cost of the total visit. You will pay only your co-pay or co-insurance after you have paid down your deductible.
Do I have a session limit?
Your insurance may limit the number of sessions that are covered per calendar year. This limit is often around 20 sessions, but it may be more, or less. Once you have reached the limit, you are responsible for the full fee for the remainder of the calendar year.
Do I need a referral from my primary care doctor to see a therapist or psychiatrist?
Some insurances require that you receive a referral from your primary care doctor in order to access benefits. If this is a requirement, be sure to request a referral from your PCP or your insurance will not cover the cost of your care.
You can also request a list of local ‘in network’ providers which can often be emailed to you.
Can I get a list of local ‘in network’ providers?
When speaking to a customer service representative from your insurance company, you can request that they email you a list of in-network providers. This list includes the contact information for the provider and often an indication of whether or not they are accepting new clients. The representative may also direct you to the insurance company website where you can do a therapist search.
What do my out-of-network benefits cover and how do they work?
- Many plans offer out of network benefits which are typically associated with a higher deductible and higher co-pays or co-insurance. Sometimes, though, the out of network benefit provides significant coverage and might be an option if you are looking for a particular specialty or identity of a provider.
- To learn about seeing someone outside of your provider network, ask your insurance company about the cost of ‘out-of-network care’ including deductible and co-pay or co-insurance.
- If you use your out-of-network benefits, you will not be offered a list of providers from your insurance company, but you can schedule an appointment with the provider of your choice.
- Typically when using out-of-network benefits, you can expect to:
- Pay in full and at the time of your visits for each session
- Request invoices from your mental health care provider stating that you have paid in full. You can clarify with your provider how often you would like to receive these (some clients prefer an invoice per session, some prefer to get an invoice monthly).
- Submit your ‘paid’ invoices to your insurance company’s claims department (address should be listed on your insurance card, but clients should always call the member’s services phone number to confirm).
- Receive reimbursement checks from your insurance company directly for a portion of the session cost (based on what out of network benefits cover)
What do I do if my insurance does not have any in-network providers in the area?
- If your insurance does not having any local in-network providers in your area, ask if you qualify for a “student rider” or ‘temporary residence rider’ allowing you to access providers in the area you live for the same cost as your in-network coverage.
- You may also consider using out-of-network benefits or connecting to lower-cost/sliding scale services.