So you’ve decided that you’re ready to seek therapy. That’s a powerful and courageous first step! You’ve taken meaningful action towards your mental health goals.
One of the first hurdles to get through on your journey is dealing with the reality of insurance. The unfortunate truth is that mental health care can be a significant cost, and the world of insurance is complex and at times, baffling. However, the important thing to keep in mind is that therapy is an investment in yourself. As our previous blog posts have pointed out, therapy offers lasting and compounding benefits, and can lead to happier and healthier lives. And with a little insurance-know-how, you’ll be equipped to find a therapy plan that works for you and your budget.
Let’s be real; seeing a therapist isn’t free, and navigating your insurance benefits can be challenging. One of the most important distinctions to make is between in-network and out-of-network providers.
In-network providers are healthcare professionals who have signed a contract with an insurance company to perform certain procedures for a set rate that the insurance company pays them.
On your side of things, this means that you’ll likely pay a co-pay (a small fee) for each session upfront. The rest of the payment is then worked out between the insurer and the provider. In-network providers are the more affordable option, and if you don’t have out-of-network benefits it may be the only way insurance will cover your costs. However, this means that in-network therapists are often booked up months in advance, and can be difficult to find.
Out-of-network providers have no contract to work with insurance providers, and are thus a more expensive option. Some healthcare plans (such as PPOs) offer out-of-network benefits which offer some coverage for providers who are out of your insurance company’s network. Typically, the process involves you paying for the full cost of services upfront, and then being reimbursed for a certain percentage of the cost of care at a later date.
The reality of the world of mental health care is that most therapists are out-of-network (Roughly 80% nationally.) There are numerous articles that delve into why this is, but it tends to boil down to a few key reasons:
When starting therapy, there are a couple of key terms that you’ll want to have a grasp of in order to understand your insurance benefits.
If you’re looking for an in-network provider, then things are generally simpler. You’ll want to know two things:
The deductible is the amount of money that a member must pay out of pocket before their insurance company will begin making payments. Typically, you won’t receive any coverage from your plan until the deductible is met. Some plans may have no deductible at all, while high deductible plans can be several thousand dollars.
Once your deductible is met, the copay is a set fee that you pay for each session, directly to your therapist. Once you pay your copay, the therapist then submits a claim to be reimbursed for the rest of their services by the insurance company.
For our-of-network providers, the process is more involved. The most important thing to know upfront is if your plan even has out-of-network benefits. If it does, that means you will have to pay for the full cost of services upfront. However, you’ll be able to submit claims to the insurance company to get reimbursed. These are the most important factors to look for if you’re seeking an out-of-network provider:
This works the same way an in-network deductible does. However, most plans have separate deductibles for in-network and out-of-network services, and out-of-network deductibles tend to be higher.
The co-insurance rate is a percentage that shows how much of the cost of care will be covered by your insurance company once your deductible is met. Co-insurance rates are typically between 10%-50%, and denote that percentage that you are seen as responsible for. For example, a 30% co-insurance rate typically means that the insurance company will reimburse you for 70% of the cost of care.
The “allowed amount”, also referred to as, “eligible expense,” “negotiated rate,” or, “payment allowance,” is the maximum dollar amount your insurance company will recognize as the value of a given service. This number can vary by zip code, procedure code, and sometimes diagnosis. This number will not be displayed on the plan documents you receive from your employer or plan administrator. To find out what this number is for you, your best bet is to call your insurance company and provide the procedure code to identify the service type, and the zip code of the clinic where you will attend your sessions.
An important thing to note is that both your deductible and your co-insurance rate will be determined by the allowed amount. The allowed amount is the maximum amount of money per visit that can be applied to your deductible, and your co-insurance rate will be applied to the allowed amount once your deductible is met. This means if the cost of a service is greater than your allowed amount, you will be responsible for the difference out-of-pocket.
Now that you’ve gotten the lay of land in the realm of insurance, what are your next steps? Most people will first want to explore their options for in-network providers. Despite the difficulty of getting set-up with someone in your network, the cost savings make it worth a try.
Once again, there are plenty of articles on how to find an in-network therapist, but I’ll lay out the basic steps here:
Another helpful resource for finding in-network therapists is Psychology Today’s Find A Therapist website. You can search through the Psychology Today database to find therapists in your area, and you can filter through options like the provider’s gender, age, issues they specialize in, types of therapy they practice, and whose insurance they work with.
Each therapist also comes with a small helpful bio, to help you understand their practice a bit better. A word of caution though: the database at Psychology Today may not always be fully updated, so be sure to double-check that any provider you find is still in-network with your insurance company before starting care.
If finding an in-network therapist isn’t a feasible option, then luckily finding someone out-of-network tends to be easier. Once you’ve found a therapist that is able to take you on as a client, it’s best to start managing your claim submission process right away. Submitting claims to your insurance provider is relatively simple, but you’ll want to stay on top of it to ensure you get reimbursed as quickly as possible.
When using out-of-network services, you’ll have to pay for the full cost of sessions upfront. Once you’ve paid for your session, your therapist will give you a superbill. A superbill is a fancy term for an itemized receipt for the service your therapist rendered. Once you have your superbill, you’ll need to submit it for reimbursement. The process for getting this information to your insurer is different for different companies; typically, it involves mailing or uploading a copy of your superbill and filling out any necessary forms. Luckily, apps like Better or Reimbursify can help you manage the process.
One strategy people have to manage the cost of therapy is adjusting the cadence of their care. Most modern forms of talk therapy encourage weekly sessions, usually between 45-60 minutes per session. However, many people go to therapy on a bi-weekly, or even monthly basis. This can be determined at the start of care or can be adjusted as you make progress. These kinds of decisions should always be discussed with your therapist, however. They can tell you if they think you’re in the right position to receive care less often, and they’ll have a better idea of the effectiveness of their own services with less frequent sessions.
If you’re looking for an out-of-network provider in the Bay Area, we are a unique option at Two Chairs. Our matching process is designed to take the guesswork out of finding the right therapist for you. We use a mix of data and your own personal experiences and preferences to match you with a therapist and custom treatment plan for you.
In addition, our Care Coordination team is there to guide you through every step of the way. We can submit claims to your insurance company on your behalf, explain your insurance benefits to you, and help with any questions you might have along the way. With our Care Coordination team handling the paperwork, Two Chairs therapists are able to focus on providing excellent quality care, and you can focus on your mental health.
The world of insurance can be daunting at first glance. But don’t panic; it is surmountable. Once you’ve decided to seek mental health care, the insurance process is often the first hurdle. But with the information and advice laid out in this article, you’re equipped to navigate the complicated waters of paying for mental health care. You’re ready to create a therapy process that works for you.
If you or someone you know is seeking mental health care, you can reach out to our Care Coordination team at [email protected] or by phone at (415) 202-5159.
If you or someone you know is experiencing an emergency or crisis and needs immediate help, call 911 or go to the nearest emergency room. Additional resources can be found here.