Does Insurance Cover Therapy? 6 Ways to Make Them Pay
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It’s easier to find affordable therapy when you have insurance with mental health benefits. But even getting the best insurance doesn’t guarantee success. It’s usually only half the battle.
Getting the most out of your insurance takes tenacity. You have to be willing to keep trying if it doesn’t work the first time. And there are many ways your insurance can let you down. It can be hard to find an in-network therapist who’s a good match—or even to find an in-network therapist at all. The worst-case scenario is when your insurance company denies your mental health claims and you have to put up a fight to get them covered.
Fortunately, it’s not always that difficult. But even when it is, there are things you can do. Read on to learn how to get more out of your mental health coverage—including how to fight your insurance company if you ever need to.
What Can You Do to Make Your Insurance Work for You?
To get the most out of your insurance, you’ll need to anticipate some of the shady tricks your insurance company might pull and know what to do if they pull them. But the very first thing you should do is get a copy of your plan booklet and learn the ins and outs of your plan.
Understanding your plan is so important. It will help you fight your insurance company if you need to, but it will also help you get more out of it even when your insurance company isn’t being shady.
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Not all the problems you might run into are ones your insurance company wants you to have, so sometimes you can get them resolved with a simple phone call or e-mail. So, before you start preparing for battle, first make sure there’s not an easy solution.
Insurance policies can be complicated and sometimes insurance companies, therapists, and customers simply make mistakes. Insurance companies try to automate as many processes as possible, and some of the ways they do that lead to lots of annoying problems they never intended to create.
No matter what problem you’re having or why, the way to deal with it is the same: know how your plan is supposed to work and hold your insurance company accountable.
Read on for our most essential tips on how to make your insurance work for you.
Know How to Use Your Insurance Company's Website and Customer Service Hotline
It can be difficult and time-consuming to find a therapist who takes your insurance and who is also accepting new clients. Having to call therapist after therapist to check if they accept your plan can get so frustrating you just want to give up.
However, there’s an easier way. The strategy is simple: instead of looking for a therapist and then asking if they take your insurance, start with a list of therapists who are in-network with your plan. The easiest way to do this is to log in to your online account.
Your insurance company’s website is an essential resource in your search for in-network therapists. Whether it’s your best resource depends a lot on your insurance company. But even if your insurance company’s website is wonky, and the in-network therapist lists aren’t as updated as they should be, it’s very likely you’ll find options on there that might work for you.
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For More Information (and a Step-By-Step Guide)
For more information, including a step-by-step guide on how to sign in and search for therapists on your insurance company’s website, you can read our article “Using Insurance to Get Online Therapy.” Many of the tips in that article apply to both online and offline therapy.
The best way to learn how to use your insurance company’s website is to set up a login and learn as you go. It may take a little experimenting at first.
Usually, it’s intuitive enough to figure out your insurance company’s website without much assistance. But if it’s a mess, and you need help, your next best resource is your insurance company’s customer support hotline. Sometimes, you can use it instead of the website. Or you can get them to help you figure out how to get the site to work for you.
The best insurance websites will give you not only the ability to look up mental health providers who accept your plan—they’ll also have filters you can use to narrow the results. You may be able to filter your search based on where therapists are located, what their specialties are, or whether they offer online sessions.
Your insurance website may also show you options you hadn’t thought of, like hospital-based therapists or integrated primary care providers.
Get a Copy of Your Policy Booklet
One weird thing insurance companies do is make it hard to find your policy documents. Even when they actually supply you with a hard copy of your policy booklet, and even when it has a clear index and Table of Contents, chances are good it’s not written in a way that makes it easy to understand.
But with a little effort (and possibly a little help), you can unlock some of its secrets and use them to get more out of your policy.
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Why Should You Read Your Policy Booklet?
Your policy booklet isn’t just a customer-facing how-to guide. It’s a binding contract with your insurance company that they are legally required to uphold. When you have a copy, you can use it to hold them accountable. So, making sure you have a copy is a great first step in getting the most out of your insurance.
To learn more about what you can find in your plan booklet, you can read our article, “How to Fight Back When Insurance Denies a Therapy Claim.”
It’s best to have a copy of both the full policy and the Summary of Benefits (SOB).
The SOB is the Cliff’s Notes version of your policy. You’ll need the full policy to be able to look up important details, but the SOB is a quick reference that helps you easily find essential facts about your plan, such as co-pays for different levels of care.
If you already have paper copies of these documents filed away, great. If not, the easiest way to find them is to log on to your insurance company’s website to see if you can find digital copies.
If you’re having trouble finding your policy booklet and SOB on your own, you can call the customer service number (which is usually listed on the back of your insurance card). They may be able to help you locate these documents on the website or even send you copies through the mail.
Get to Know Your Policy
Once you have a copy of your policy booklet, flip through it to see what you find. If you’re not sure what certain terms mean, you can find tips and guides online, like this set of tools from Healthcare.gov.
Knowing exactly what your policy booklet says about your mental health benefits empowers you to get the most out of your insurance.
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How to Navigate Your Plan Booklet
You can learn a lot by following these three steps:
- Confirm that you have mental health benefits. Two easy ways to do this are to look for “mental health” in the index of your plan booklet or, if you have an electronic copy of your policy, do a text search on your computer using Ctrl+F or Cmd+F.
- Look for any lists or descriptions of covered mental health benefits. The more specific the information, the better. Take note of any specific mental health services or provider types that are listed as covered in your policy booklet.
- See if you can find any exclusions, or types of mental health treatment that aren’t covered by your policy.
Note that your plan may use another term besides “mental health” for your mental health benefits, such as “behavioral health” or “psychiatric services.”
Even if you’re not completely sure what everything in the mental health section of your policy means, knowing just a little can go a long way. Insurance companies overturn denied claims and pay them when you can show that the policy language means they should have covered them.
And even if you’re not dealing with a denial, knowing what your insurance policy says it covers empowers you to seek covered care and submit claims for it.
Think Outside the Box
There are more ways to use your mental health benefits than you might realize. In fact, insurance can open up a whole new world of therapy options you may not have considered before.
While the number of private practice therapists who accept insurance is limited, there are other kinds of providers who almost always accept insurance.
Hospitals and clinics run by large health systems nearly always take insurance, for example. So do most public mental health programs. In fact, there’s a good chance that any large mental health agency you look into—whether it’s a non-profit, publicly-funded, or for-profit agency—will accept insurance.
If your insurance company’s website is good, it should show you some of these options when you search for in-network mental health providers. Sometimes, though, you might have to connect some dots yourself.
For example, if you see that your insurance covers hospitals and clinics in one of your major regional health systems, you might want to do your own research to see if that hospital system runs any mental health clinics that accept your insurance. Keep an eye out for local mental health non-profits, too.
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Try an Online Therapy Platform that Accepts Insurance
If you’re having trouble finding local in-network therapists, you might want to consider trying an online therapy platform that accepts your insurance. Some online mental health platforms that accept insurance include:
After you confirm that the platform accepts your specific insurance plan, it’s important to check whether all therapists on the platform accept your insurance or only certain ones.
You’ll also want to know how billing works. For more in-depth information on how to use these platforms, you can read our article on how to use insurance to get online therapy.
To find listings for affordable local non-profits and publicly-funded providers, you can search the OpenCounseling affordable counseling database or go to our page about your state’s mental health system. The providers you find may clearly list on their websites which insurance policies they accept, or you may need to make a quick call to get that information.
These providers often accept insurance plans that other providers don’t. (For example, most public mental health agencies accept Medicaid, while most therapists in private practice don’t.) Knowing to include them in your search increases your chances of finding an in-network provider.
Know Your Rights
While we don’t offer legal advice at OpenCounseling and encourage you to seek a lawyer if you need legal help, we do recommend that you learn what the law says about how your policy should work and what you have a right to expect from your insurance company. You don’t have to be an expert to be able to use your knowledge of healthcare law to stand up for your rights.
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The two most important healthcare laws to know about are:
- The 2008 Mental Health Parity and Addiction Equity Act (Parity Act) and
- The 2010 Patient Protection and Affordable Care Act (Affordable Care Act or ACA)
To learn more detailed information about these and other laws and the rights they give you as an insurance consumer, you can read our article, “How to Fight Back When Insurance Denies a Therapy Claim.”
We also review some of the most important aspects of the Parity Act and Affordable Care Act below.
The Parity Act prohibits insurance plans with mental health benefits from limiting those benefits more than they limit medical benefits.
This means if your plan doesn’t restrict the number of visits you can make to medical specialists every year, it can’t restrict the number of visits you can make to mental health specialists, either. (In other words, it shouldn’t be able to limit the number of therapy sessions you can get in a year.) It also means that co-pays should be the same for the same levels of outpatient medical and mental health care.
The Affordable Care Act enhanced and extended the Parity Act. It also required new plans to cover mental health care as one of ten “essential benefits.” This means that plans created after March 10, 2010, should include comparable medical and mental health benefits.
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Exceptions to the Affordable Care Act
There are some exceptions, though. “Grandfathered” plans that existed before March 10, 2010, don’t have to comply with the requirements of the ACA. Small businesses with less than 50 employees are also exempt from the mandate to provide mental health insurance.
Even knowing the basics about these laws can empower you if a claim gets denied. It can also inform your choices when you sign up for or change insurance plans.
Fight Back If Your Claims Are Denied
One trick insurance companies use to try to get around the requirements of the ACA is to automatically deny certain kinds of mental health claims.
On paper, they may not seem to impose additional limits or restrictions on mental health care. In practice, however, they seem to find more reasons to deny mental health claims for “lack of medical necessity” than they do medical claims (though they use this practice with medical claims as well).
If an insurance company denies one of your claims as “medically unnecessary,” it means they don’t believe you needed the care you received—or at least don’t believe that it fit their criteria for medical necessity. (These criteria are usually in conflict with the criteria healthcare providers use to determine whether you need a certain type or level of care.)
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Watch Out for This Nasty Trick!
Insurance companies will sometimes deny claims as medically unnecessary because you didn’t try a lower level of care first. This practice, sometimes referred to as “step therapy” in healthcare law lingo, was technically outlawed by the Parity Act. However, some insurance companies still try to get away with it.
You can fight back by appealing the denied claim. To appeal, you need to make a clear argument about why the insurance company should have paid the claim based on the coverage outlined in your plan booklet. You also need to gather evidence that supports your argument.
Your policy booklet should provide an outline of the appeal process. Most insurance companies start by having you submit an “internal appeal” directly to them. If they uphold the denial, you may be able to appeal to an independent review board affiliated with your state’s Department of Insurance. (This depends on the type of appeal and the state you live in.)
To learn more about how the appeal process works, you can read our full article about it here.
What Do You Do If Your Insurance Still Isn't Working for You?
If you’re having a hard time finding a therapist in your insurance network who’s the right fit—or you’re having a hard time finding any in-network therapists at all—you’re not alone.
Insurance companies may be intentionally restricting their networks to limit the amount of in-network mental health care available to consumers.
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Why Doesn't Insurance Work Better Than It Does?
You’re not paranoid if you think your insurance company is working against you. They probably are. In fact, when it comes to how they handle mental health claims, many insurance companies have been found guilty in court of unfair, dishonest, or discriminatory practices.
Dirty tri...
You’re not paranoid if you think your insurance company is working against you. They probably are. In fact, when it comes to how they handle mental health claims, many insurance companies have been found guilty in court of unfair, dishonest, or discriminatory practices.
Dirty tricks in insurers’ playbooks include:
- Denying mental health care claims as “medically unnecessary.”
- Limiting or restricting the number of therapy sessions that you can claim.
- Creating “ghost networks” that make it harder to find in-network therapists.
- Shifting more costs to consumers through higher co-pays, premiums, and deductibles.
Your insurance company wants you to think you have a great policy, but they don’t want you to know they’re fighting against your ability to use it.
Sometimes all you have to do to get them to pay is to stand your ground. Many automatic mental health claim denials are overturned as soon as you appeal them. (You can read this article to learn more about what to do if one of your mental health claims gets denied.)
If there’s one thing insurers count on, it’s that you won’t fight back when they deny a claim or otherwise make it hard to use your insurance. But not only can you fight back when claims are denied, you can proactively prevent other insurance-related issues by knowing your policy and your rights.
It’s not always the insurance company’s fault, though. There simply may not be enough mental health workers where you live, especially if you live in a rural area. The mental health workforce shortage is a growing issue around the country.
One way to deal with the shortage of in-network providers is to use out-of-network benefits to get partial coverage of out-of-network care. Beware, though—using out-of-network benefits can be tricky and comes with hidden catches. We highly recommend that you read our article on using them to learn how they work and how to avoid some of the headaches they can cause.
If all else fails, you can ditch your insurance altogether. Just because you have insurance doesn’t mean you have to use it. You’ll often have more options when you don’t. Sometimes, you can even save money by not using it.
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You might want to consider paying out of pocket for therapy when:
- You need a specific type of therapy, and can find it in your area, but not from anyone who accepts your insurance.
- You don’t have out-of-network benefits and all of the in-network therapists in your area have long waiting lists.
- You’ve found a therapist who’s a perfect match. They don’t take your insurance, but you can afford their sliding-scale rates.
If you can find a therapist who’s a good match, who can schedule you for an appointment soon, and who charges rates that fit your budget, it may not be worth the wait or hassle of using your insurance for therapy.
Also consider any special resources you may have where you live. You may be able to get affordable therapy at a university community counseling clinic, a local non-profit, a public mental health agency, or an integrated healthcare clinic. Some of these provider types may even offer therapy for free or for less than your co-pay to see an in-network provider would cost. (Do note that some, but not all of these programs limit eligibility to people who don’t have insurance.)
Conclusion
It would be great if insurance worked better than it did. The main reason it doesn’t is that our healthcare system is beholden to insurance companies who make their profits by denying care. Unfortunately, the battle to fix these systemic issues is proving to be a long and difficult one.
Fortunately, though, there are things you can do even within this flawed system to stand up for your rights and get the care you need. One is to know and use your local mental health resources, including mental health non-profits who provide affordable alternatives to the uninsured or underinsured.
Another way to advocate for yourself is to understand your insurance plan, what it covers, and what it’s supposed to cover. With the right efforts, you can often find a good in-network therapist whom you can see for the cost of an affordable co-pay.
If you can’t find the right therapist in your insurance network right away, don’t give up. There may be hidden options you didn’t realize you had, such as seeing a therapist at a clinic that accepts your insurance.
You may be able to use out-of-network benefits instead or find out-of-pocket care you can afford at a local non-profit. We encourage you to search our affordable counseling database if you’ve run into a dead end. It may just spark some ideas and lead you to the therapist you’ve been looking for.