Mental Health Insurance Coverage Guide
Navigate insurance benefits, verify coverage, and maximize your mental health care.
Understanding Your Mental Health Benefits
Most health insurance plans cover mental health services—but navigating coverage can be confusing. This guide helps you understand your benefits, verify coverage, and make informed decisions about therapy costs.
Mental Health Parity Law
The Mental Health Parity and Addiction Equity Act (MHPAEA) requires most insurance plans to cover mental health and substance use disorder services equally to medical/surgical benefits. This means similar copays, deductibles, and treatment limitations.
What Mental Health Insurance Typically Covers
✓ Usually Covered
- • Outpatient therapy — Individual, couples, family, or group therapy sessions
- • Psychiatric evaluations — Diagnostic assessments and medication management
- • Psychological testing — When medically necessary
- • Inpatient/residential treatment — For severe mental health crises
- • Partial hospitalization — Intensive outpatient programs (IOPs)
- • Medication — Psychiatric medications (often through pharmacy benefit)
✗ Usually NOT Covered
- • Life coaching — Not considered medical treatment
- • Non-medical therapy — Wellness counseling, personal growth without diagnosis
- • Court-ordered evaluations — Custody evaluations, forensic assessments
- • Educational testing — Learning disability evaluations (may be school district responsibility)
- • Alternative therapies — Massage, acupuncture (unless specifically included)
- • Services by unlicensed providers — Peer counselors, coaches (unless supervised)
How to Verify Your Mental Health Coverage
Before starting therapy, call your insurance company to verify coverage. Have your insurance card ready and ask these specific questions:
1
Coverage Questions
- • "Does my plan cover outpatient mental health services?"
- • "Are therapy sessions covered for [anxiety/depression/specific diagnosis]?"
- • "Do I need a referral from my primary care doctor?"
- • "Is pre-authorization required before starting therapy?"
2
Cost Questions
- • "What is my copay for outpatient mental health visits?"
- • "What is my deductible, and have I met it for this year?"
- • "After I meet my deductible, what percentage does insurance cover (coinsurance)?"
- • "What is my out-of-pocket maximum for the year?"
3
Provider Network Questions
- • "Is [therapist name] in-network with my plan?"
- • "If I see an out-of-network provider, what percentage is covered?"
- • "Do out-of-network visits count toward my deductible?"
- • "Can you provide a list of in-network therapists in my area?"
4
Session Limits
- • "Are there limits on the number of therapy sessions per year?"
- • "Do I need continued authorization after a certain number of sessions?"
Important: Write down the date, time, and name of the representative you spoke with. Ask for a reference number for the call. Keep these notes in case of billing disputes.
Understanding Insurance Terms
Copay (Co-payment)
A fixed amount you pay for each therapy session (e.g., $30 per visit).
Example: Your copay is $40 for each therapy session, regardless of the full cost.
Deductible
The amount you must pay out-of-pocket before insurance starts covering services.
Example: $1,500 deductible means you pay the full session cost until you've spent $1,500, then insurance kicks in.
Coinsurance
The percentage you pay after meeting your deductible (e.g., you pay 20%, insurance pays 80%).
Example: After your deductible, you pay 20% of a $150 session ($30), insurance pays $120.
Out-of-Pocket Maximum
The maximum you'll pay per year. Once reached, insurance covers 100% of covered services.
Example: $5,000 out-of-pocket max means once you've paid $5,000, insurance covers everything else that year.
In-Network vs Out-of-Network
In-network: Providers with negotiated rates with your insurance (lower cost to you).
Out-of-network: Providers without contracts (higher cost, may require reimbursement process).
Pre-authorization (Prior Authorization)
Approval required from your insurance before receiving certain services (e.g., intensive treatment, extended therapy).
Usually required for: inpatient treatment, intensive outpatient programs, sometimes ongoing therapy.
Getting Reimbursed for Out-of-Network Therapy
Many insurance plans offer out-of-network benefits, which allow you to see any licensed therapist and get reimbursed for a portion of the cost. Here's how:
Step 1: Verify Out-of-Network Benefits
Call your insurance and ask:
- • "Do I have out-of-network mental health benefits?"
- • "What percentage do you reimburse for outpatient therapy (CPT code 90834 or 90837)?"
- • "Is there an out-of-network deductible?"
Step 2: Pay Your Therapist
Pay the full session fee to your therapist at the time of service.
Step 3: Get a Superbill
Ask your therapist for a superbill—a detailed receipt with:
- • Therapist's name, credentials, NPI number, Tax ID
- • Your name and date of birth
- • Date of service
- • CPT code (procedure code, usually 90834 or 90837)
- • Diagnosis code (ICD-10)
- • Amount paid
Step 4: Submit for Reimbursement
Submit the superbill to your insurance via:
- • Online portal: Upload through your insurance website/app
- • Mail: Send superbill to claims address on your insurance card
- • Fax: If provided by insurer
Step 5: Receive Reimbursement
Insurance will send you a check (or direct deposit) for the covered portion, usually within 2-6 weeks.
Pro Tip: Some therapists can submit claims on your behalf. Ask if your provider offers this service.
Online Therapy Platforms & Insurance
Do Online Therapy Platforms Accept Insurance?
✓ Platforms That Accept Insurance:
- • Talkspace: Accepts some insurance plans
- • MDLive: Widely accepted by insurance
- • Amwell: Insurance accepted
- • Teladoc: Often covered through employer benefits
- • Many individual therapists on platforms like Psychology Today offer in-network or out-of-network billing
✗ Platforms That Don't Accept Insurance:
- • BetterHelp: Self-pay only (but may provide receipts for FSA/HSA or out-of-network reimbursement)
- • Cerebral: Self-pay with some FSA/HSA options
Note: Even if a platform doesn't directly bill insurance, you may be able to submit superbills for out-of-network reimbursement. Check with the platform and your insurance.
What If You Don't Have Insurance?
Sliding Scale Therapy
Many therapists offer sliding scale fees based on your income. Ask therapists if they offer reduced rates.
Community Mental Health Centers
Federally funded centers provide low-cost or free therapy based on income. Find one at HRSA Health Center Finder.
University Training Clinics
Graduate students in clinical programs offer therapy at reduced rates under licensed supervision.
Employee Assistance Programs (EAP)
Many employers offer free short-term counseling (usually 3-8 sessions) through EAPs. Check with your HR department.
Online Therapy Platforms (Lower Cost)
Platforms like BetterHelp (~$240-360/month) are often cheaper than traditional therapy without insurance ($150-250/session).
Compare affordable online therapy platforms →Crisis Support
If you're in crisis, free support is available 24/7: