How to Find a Therapist Covered by Insurance
June 9, 2023
Are therapists covered by insurance?
We know how you feel, because we’ve all been there: nervously googling how to find a therapist that takes my insurance and hoping for a silver bullet solution. Here’s the less-than-silver answer. Insurance coverage for therapists, such as mental health therapists, counselors, or psychologists, varies depending on your specific insurance plan and the country or region you are in. In many cases, finding a therapist covered by insurance is a realistic possibility, especially when mental health services are deemed medically necessary.
In the United States, for example, most health insurance plans, including those provided under the Affordable Care Act (ACA), Medicare, and Medicaid, are required to cover mental health services, including therapy. However, the extent of coverage can vary depending on your specific insurance plan.
Finding a therapist that takes my insurance
To find a therapist accepting insurance it helps to search the smart way. By this we mean, know what kind of provider and care you’re looking for, before you look. Some factors that can affect your insurance coverage for therapy include:
- In-network vs. out-of-network providers: Your plan may cover therapy services only when provided by in-network therapists. Out-of-network providers may have different coverage rates or not be covered at all.
- Session limits: Some insurance plans may limit the number of therapy sessions they cover per year or per condition.
- Deductibles, copays, and coinsurance: Depending on your specific plan, you may be responsible for deductibles, copays, or coinsurance when receiving therapy services.
- Pre-authorization or referral requirements: Your insurance plan may require pre-authorization or a referral from your primary care physician before covering therapy services.
To determine the extent of your insurance coverage for therapy, review your policy documents or contact your insurance provider directly. They can provide details on your plan's coverage, any limitations, and the steps you need to take to access covered therapy services.
How to find an affordable therapist covered by insurance
Now let’s get into the specific financial aspects of how to find therapy covered by insurance. We wanted this to flow like a decision tree, so we organized your main options from cheapest to most expensive. But know that costs can vary, so this list is just a starting point. (We offered some less financial, more conceptual advice on this topic in Finding a Therapist.)
Option 1: Therapists that accept insurance in your network
As we mentioned before, most insurance plans have a list of approved mental health providers in their network. Start there for the cheapest option. You may have a small set of providers to choose from, but you will almost certainly pay less than you would for an out-of-network therapist.
This is because with an in-network provider, your insurer will cover a greater percentage of your costs. Also, your in-network deductible is almost certainly lower than your out-of-network one, so your benefits kick in sooner. Go to your insurer’s website to search for therapists within your network.
Note: If your insurer’s site is not getting the job done, the American Psychological Association has a tool for finding counselors in your area. The APA’s locator lets you see which network they belong to—you can search by your network to only see in-network therapists.
Option 2: Out-of-network counselors with pre-authorization
If you need a specific mental health service, but there is not a specialist in your network who can provide it, your plan may offer something called pre-authorization. Pre-authorization entails a note from your insurer authorizing you to receive a certain OON service at an in-network rate. It may be a useful option if you are seeking a highly specific service, like EMDR.
Pre-authorization can save you a lot of money. Unfortunately, it is a time-consuming process, and many insurers can be stubborn about it. However, if your pre-authorization is rejected, you may still have a chance to pay an in-network rate with Option 3.
Option 3: The network (gap) exception
A network (gap) exception is very similar to a pre-authorization. Also known as a gap exception or a network deficiency, it is a tool health insurance companies use to compensate for gaps in their network of contracted healthcare providers.
As with pre-authorization, if you are granted a network exception you will pay in-network prices for out-of-network services. The difference is that while a pre-authorization refers to specific services, a network exception refers to providers. Still, the terms may be used interchangeably by your insurer. If you are seeking a specialized form of therapy, contact your insurer to see if you can receive a network exception. It may save you a great deal of money.
Option 4: Paying everything out of pocket
While this is likely the most expensive option, it does offer the greatest freedom. Technically, you can see any counselor you wish to see, regardless of your insurance plan. Some states have restrictions on therapy across state lines, but assuming you are staying in-state, or you live in a state that does not restrict therapy across state lines, you have the freedom to see any therapist you wish.
This option is useful for anyone seeking a specific type of therapy that cannot be pre-authorized, because greater selectivity can make a big difference. If your insurer will not grant you a network exception, you can always pay out of pocket and submit your superbills for reimbursement.
While it's difficult to provide a comprehensive list of therapy types that cannot be pre-authorized, there are some instances in which insurance companies may be less likely to authorize coverage:
- Experimental or unproven therapy: Insurance companies are generally more hesitant to cover therapy that lacks sufficient scientific evidence supporting its effectiveness or is considered experimental.
- Non-medically necessary therapy: If a therapy is deemed not medically necessary or is primarily for personal growth, self-improvement, or stress management, insurance companies may not provide coverage or require pre-authorization.
- Alternative or complementary therapy: Some alternative or complementary therapies, such as acupuncture, massage therapy, or herbal remedies, may not be covered by insurance or may have limited coverage depending on the plan.
- Treatment beyond plan limits: If you have already reached the maximum number of sessions or coverage limits allowed by your insurance plan, further therapy sessions may not be authorized.
What to do if you can’t afford therapy
The cost of therapy can be an issue for a lot of patients. This is completely understandable. If you are concerned about how to afford therapy, you are certainly not the only person in this boat. Most therapists have encountered this situation plenty of times.
For that reason, many therapists accept payment on a sliding scale. The key is communication. Don’t be afraid to ask your therapist if they can offer you a discounted rate. If you do not ask, you will never know the answer.
With the recent push for greater access to mental health care, some therapists even make it their mission to provide therapy at every price point. You can also ask the provider if they know anyone offering more affordable mental healthcare. Most therapists would be happy to refer you to someone who better suits your financial situation.
Lastly, and we cannot say this enough: double-check your out-of-network benefits. You may be surprised by how much of your therapy costs your insurer has agreed to cover. Often, patients throw away their superbills when they should be saving them to file them for reimbursement! People make the mistake of assuming their plan does not cover OON therapy services, leaving money on the table.
How SuperBill helps you find a therapist covered by insurance
If you do have OON benefits, or you’re unsure if your insurance covers therapy, SuperBill may be able to help! SuperBill verifies your benefits, then files and tracks your out-of-network claims. We will update you on the status of your claim at every interval, and do everything we can to get it reimbursed. We even help with medical bill negotiation!
If you’re seeing an out-of-network therapist, you can jump through all the hoops to make sure your therapy is covered by insurance, OR you can let SuperBill for insurance handle it all for you. We have worked with countless patients to get them the reimbursement they deserve.