It depends. Some therapists submit claims to insurance companies the way other doctors and clinicians do, and they may work only with certain plans. Other therapists will ask you to pay for services up front and then submit the claim to your insurance company yourself to get reimbursed for all or part of the service.
Whether your insurance plan covers part or all of the cost of therapy for mental health depends on your provider and your specific plan.
Mental Health Parity Laws Require Insurance Reimbursement for Treatment of Mental Illness, but Not All Mental Health Care
And legally, many plans are required to provide equivalent coverage for any care related to the treatment of a mental health diagnosis, as the plan would pay for physical health issues.
NAMI provides resources for individuals who suspect their insurance provider is not following these regulations.
But note that this mental health parity legislation requires coverage only for clinically diagnosed mental health disorders. That means that if you’re seeking therapy for mental or emotional health without a diagnosis, your insurance isn’t legally required to pay for it, Bufka says.
“Health insurance is predicated on treating a health condition, so when you’re billing your insurance provider, it must show what the diagnosis is and what service was provided,” Bufka says. Some insurance providers and plans may still cover preventive mental services (or therapy without a clinical diagnosis), but the only way to know is to check your specific plan and policy details.
It’s worth noting that an additional barrier to effective mental health care coverage by insurance companies is inadequate provider networks. If there’s a shortage of mental health providers who are “in network” (providers your insurance company will reimburse you for seeing), it’s going to be challenging for you to get good mental health care.
How Do I Find Out if My Insurance Covers Therapy?
To find out if your insurance provider will cover the therapy and practitioner you’re interested in, you’ll likely need to do some research before your first appointment. You can:
- Contact your insurance provider. For starters, pick up the phone and call your insurance company to ask for detailed information on what’s covered, a list of approved therapists or mental health services in your neighborhood, and how you can make a claim, Bufka says. Your provider’s website may have an online portal where you can see what services are on offer and connect with therapists who are in network.
- Contact your therapist. Check your therapist’s website or contact them directly to see which insurance plans they accept and if they’ll submit claims directly to your insurance company (or if you need to do it after your appointment), Morrison says. You may learn at this step that the therapist you were hoping to work with is not in network and doesn’t accept insurance at all. Note: That doesn’t necessarily mean your insurance company won’t cover some or all of the costs of your care, but if the provider doesn’t work directly with insurance companies, you may be on the hook for paying for service up front and then sending the necessary paperwork to your insurance company (if your insurer will reimburse you), Morrison says.
- Consider contacting your employer’s human resources department. If your health insurance is provided by your employer, you may be able to get started by contacting your HR department. In some cases, they may have an employee assistance program to connect you with the resources you need. But remember, whether or not you choose to disclose to your employer (or your HR department) that you are seeking therapy for mental health is up to you. And know that you are never legally required to disclose a psychiatric issue to an employer (unless you are requesting a job accommodation).