Fees & Insurance

Should You Use Insurance to Pay for Therapy?

One issue people often wonder about when they consider beginning or returning to psychotherapy is how to pay for it. Some with health insurance choose to use those benefits when participating in therapy or counseling. Some with health insurance choose not to use those benefits when participating in therapy or counseling. There are a number of points to consider when making a decision about whether to use your health insurance coverage to partially fund your mental health treatment.

Coverage for Mental Health Care

In 2008, the Mental Health Parity and Addiction Equity Act put mental health care and substance use disorder services on equal footing with medical and surgical coverage. Insurers who offer mental health coverage cannot charge higher co-pays for mental health services than for most other health care services. They also have to allow as many outpatient visits for therapy as they do for medical or surgical coverage. Beginning in 2014, the Affordable Care Act (ACA) expanded on those benefits by including mental health care and substance use disorder services in the 10 essential health benefits that individual and small group insurance plans and Medicaid Alternative Benefit plans must cover.

Paying Out of Pocket

Some people choose to pay for therapy themselves because doing so provides additional privacy or flexibility.

When you agree to use your health insurance coverage to pay for a portion of your mental health treatment, you consent to communication of your Protected Health Information to your health insurer. These details can include a mental health diagnosis and dates of sessions with your psychologist, therapist, or counselor. Your health insurer can also request additional documentation from your provider to include more detailed notes summarizing your session-by-session progress in treatment.

Your psychologist, therapist, or counselor must assign you a mental health diagnosis in order for you to use your health insurance coverage to pay for a portion of your mental health treatment. In doing so, your insurer will have information about your mental health treatment history. This information may then be added to your Medical Information Bureau (MIB) record. Your MIB profile may be used by various life/health insurance companies to determine your risk or eligibility when you apply to purchase a life, health, disability, or long-term care insurance policy. Your mental health history as shared by your health insurer with the MIB may increase your cost to purchase one of the above policies or simply render you ineligible to purchase such a policy because of a pre-existing mental health condition.

In addition, health insurers don’t typically cover all types of therapy or all psychologists, therapists, or counselors in your community. For example, marital therapy is rarely covered by health insurers. And, more experienced psychologists, therapists, or counselors or those offering a specialty service may not be contracted with your health insurance company.

Using Your Health Insurance Benefits

Health insurance can make therapy available to those who otherwise could not afford such treatment. If you have health insurance through your employer or purchase it yourself, you may want to take advantage of those benefits. If so, call the customer service number on the back of your health insurance card to confirm your mental health (sometimes termed “behavioral health”) benefits. Asking about co-pays, deductibles, and if your health insurance plan uses provider networks can help you understand your share of the cost of therapy.

An Investment in Your Well-Being

Whether you choose to use health insurance or pay out of pocket for therapy, know that psychotherapy works, it’s good for your health, and is more than a quick fix.

I regularly work with individuals who opt not to use their health insurance benefits because of concerns discussed above. I am also credentialed as an in-network provider with many health insurance plans to include:

DMBA
EMI
PEHP
Tricare
Medicare
University of Utah Healthy Premier/Preferred

I’m happy to answer questions surrounding the pros and cons of using health insurance benefits to pay for mental health treatment and help you reach a decision that best meets the needs of your unique situation.

I’m currently accepting new patients – both self-pay and insurance-based. Rates are $180-200 for your initial evaluation (60 minutes) as well as for ongoing individual therapy (45-55 minutes/session).

I invite you to call or email me to get started working together.