This article is part of In Session: The Teen Vogue Lesson Plan. Find the full lesson plan here.
There’s no shame in needing help coping with your mental health, and there’s no shame in not knowing how to start the process of finding it. Figuring out how to access therapy isn’t always easy, and can be confusing even for the most experienced consumers. But, understanding what you’re up against is the first step. If you have health insurance, you’re one step closer to finding affordable therapy, but first you have to learn how to use your insurance and understand your benefits (if you don’t have insurance, don’t worry. You can still find affordable therapy — more resources on that here).
“Insurance is complicated for most adults who have used their health insurance in the past,” New York therapist Dhvani Patel Lindsey, LMFT said. “So if you are confused or worried about how to navigate it, you’re not alone. It does take some time to educate yourself, but the information is out there.”
To help with the process of booking your first therapy session, Teen Vogue has put together a guide of some of the most common questions, terms, and concerns you might run into when you start trying to figure out if your insurance plan can help with the cost of therapy.
Here’s what you need to know about accessing your health insurance benefits.
Does health insurance cover therapy?
It certainly can! All health insurance plans are different, so it depends on what specific plan you have. Whether your therapy will be covered also depends on what therapist you choose. Some therapists only take specific insurance, while some don't accept insurance at all. That's why all of this can be so confusing — there are many variables that can impact your situation, and that can feel overwhelming in and of itself. But by asking the right questions, you can totally figure this out. So, let's get into the kinds of questions you can ask and who to ask them of.
The easiest way to find out what your plan covers is by finding a schedule of benefits
A schedule of benefits is a document that outlines the costs associated with all of the health care services that are covered by your plan.“It is like a spreadsheet of your costs for different types of services, they'll have what your mental health care costs,” Lindsey said. “Before you start your search for your therapist, you want a realistic sense of what the cost might be.”
You can find your schedule of benefits online by looking up your health insurance provider and the type of plan you have — this information can be found on your health insurance card. Once you’ve located the most up-to-date version of your schedule of benefits, you can search for mental health benefits and see what the cost may be.
Understanding your schedule of benefits
There are a couple of important terms that are key to understanding your schedule of benefits and how much therapy may cost for you.
- Copay – a fixed amount you pay for therapy once your deductible has been met and/or if your insurance covers some of your therapy costs. This amount won’t vary, so you’d be able to budget for the cost. For example, you might have to pay $30 each time you have a session — that flat-rate fee is your copay.
- Co-insurance – this is the percentage of the total cost of a therapy session you pay after you meet your deductible or if your insurance won't cover all of your therapy costs. Like a copay, this amount is fixed and will be the same every time you see your therapist.
- Deductible – this is the amount you have to pay before your health insurance kicks in. For example, if your deductible is $1,000, this means that you spend $1,000 on health care costs before your health insurance starts to cover your health insurance expenses. Deductibles can range based on the plans, and some health insurance companies are waiving deductibles for mental health services during the pandemic.
- In-network – an in-network therapist is someone who has an existing contract with your health insurance provider, so your therapist bills your insurance provider, which then pays the therapist directly. In-network therapists tend to have lower or no co-pays than someone out of network.
- Out-of-network – if your therapist is out-of-network, it means that your provider does not have an existing contract with the therapist. Out-of-network therapists typically cost more out of pocket, but don’t let that totally deter you. “I've had clients who have great out-of-network benefits, and they're reimbursed 80 or 90% of the cost,” Lindsey said. “It depends on your specific insurance plan.”
- Reimbursement – if your therapist is out of network, your health insurance may reimburse you a portion of the cost. This reimbursement is sent via check, and you would be required to pay your therapist their full fee upfront. It's also worth noting that some therapists don't take insurance at all. In that case, asking if they offer a sliding fee scale can help you figure out if you can afford them.
Note that reimbursements can be a little tricky. While some out-of-network therapists will submit insurance claims on your behalf, claims can take up to forty-five days to be reimbursed. If your therapist is not able to file insurance claims, you have to do it yourself. Lindsey said that a lot of her clients use the app Reimbursify to submit their insurance claims after they receive a superbill – another term for an invoice of services – from her.
If your health insurance does not cover mental health benefits until your deductible has been met, you may want to look into alternative therapy options. Some therapists will offer a sliding scale payment option based on how much a client can afford. If you are interested in these options, you can ask potential therapists if they have a low fee or no-fee services.
If you have questions about whether your deductible has been met, you can call your health insurance provider using the number on your health insurance card. Asking the following questions may help you gain some more clarity on your plan’s benefits:
- What is my deductible, and has it been met?
- What is my copay?
- Is the therapist I want to go to in or out of network?
- How many sessions per year does my health insurance cover?
- Do I have to have a mental health diagnosis to have sessions covered?
- How often do you provide reimbursement/ When are the superbills due?
What to ask your therapist
One of the most important things when looking for a therapist is how you feel about them. “Research shows that the most important factor in therapeutic success is the client-therapist fit." Lindsey said.
You can find a list of therapist directories that let you search by your health insurance provider on Teen Vogue and more information about how to find the right therapist for you. Many therapists will offer free phone consultations where you can discuss some of your goals for therapy and learn more about a therapist you may want to work with.
During your phone consultation with a potential therapist, leave some room at the end of the call to talk through some of their payment options. Here’s a list of questions you should ask your therapist to understand how their practice deals with billing:
- Can you file insurance reimbursement claims on my behalf?
- Do you provide a superbill that I can submit to my insurance company?
- What information do I need to provide to you for billing purposes?
You don’t necessarily have to tell anybody you’re going to therapy
Some people think that if you plan on using your parents' health insurance to cover therapy costs, but that isn’t always the case.
You can call your health insurance provider and request an explanation of benefits to be sent directly to you, instead of your policyholder. An explanation of benefits is a statement that describes the cost of the care you received and how much your health insurance covered, as well as the medical expenses you would be responsible for. Under the Health Insurance Portability and Accountability Act (HIPAA), health insurance providers are required to protect patient confidentiality, and some states have taken further measures to ensure that people on their parents' health insurance would be able to protect this right. Still, it might depend on where you live and your specific insurance company, so it's possible your insurance won't comply with your request.
But that doesn't mean it's not worth asking.
If you’re interested in protecting your confidentiality, call your health insurance provider and explain that you would like reimbursement checks and explanations of benefits addressed to you, not your policyholder. If they agree, then you're in the clear. If they say that they will only send the explanation of benefits to the policy holder (i.e. your parents), then it might be time to have a frank conversation with your parents about your plans if you feel safe doing so.
"If you feel like your parents are going to have concerns, hear them out," Patel said. "Ask them what their concerns are because they might be reacting to past stigma around therapy, and not the reality of what mental health care is like now."
You can also talk to potential therapists about your privacy concerns, and work with them to ensure that you feel that your confidentiality is protected.
Here’s the thing – therapy works
Deciding to see a therapist can seem like a daunting task, especially considering the cost and the complicated world of health insurance. However, the benefits of therapy cannot be overstated – it’s been proven to reduce depressive symptoms, and can provide a safe space for you to learn more about yourself. So if you feel like your mental health is having a significant impact on your life, consider looking into therapy. It can be scary, but in the end, it may be worth it.
“The greatest benefit of therapy is honestly just the self-exploration and the self-awareness that comes with it, and I think that's something that everyone can use,” Lindsey said.