There are a lot of things to consider before starting therapy, but for many of us, the primary concern is financial.
Accessing therapy can be expensive, but an insurance provider offers a potential solution.
Insurance is intended to cover necessary health costs, and this does include mental health treatment.
Most insurance providers will offer coverage for some forms of therapy, with a small copay required from the client.
Therapy with insurance is a fraction of the price of standard therapy, but the actual cost is variable.
In this guide, we’ll take a look at how much you might expect to pay when seeking therapy on insurance.
Does Insurance Cover Therapy?
Yes, insurance is required to cover mental health services, including therapy. However, it comes with certain caveats. Insurance is only required to pay for “medically necessary” services.
What’s necessary can be tricky to determine when it comes to therapy.
Because insurance is only for medically necessary therapy, many providers require a diagnosis before they cover the costs. Some will even require a treatment plan, and an end date for the treatment.
An insurance provider might also require a referral, before they cover therapy.
Unfortunately, this can make it hard for even those in need to access mental health services with insurance. Offering an immediate diagnosis and treatment plan might not be possible, and even then, an insurance provider might reject the diagnosis.
For these reasons, even those with insurance will sometimes choose to pay out of pocket (to find out more about therapy insurance, read here) (to find out more about therapy insurance, read here).
How Much Is Therapy With Insurance?
Mental health care is becoming increasingly prominent in the US, and health care insurance providers need to keep up.
Many insurance providers do offer coverage for mental health care, although the client is typically expected to pay a “copay”.
Seeking mental health services with insurance can significantly lower the cost of therapy.
With insurance, therapy can cost anywhere from a few dollars to over $50. This is how much the client is expected to cover as a copay.
The price varies depending on location, insurance provider, and therapist.
Insurance providers will offer to reimburse part of the payment for therapists within their network.
Even if you have insurance, an out-of-network therapist might still cost you the full amount. Depending on the therapist in question, this could be between $50 and $300.
Overall, choosing an in-network therapist through insurance means you might be expected to pay between $20 and $30 per session.
The exact costs vary, but insurance should cover the majority of the payment.
How Much Is A Copay For Therapy?
The copay is a small portion of the overall fee for a service.
For therapy, this copay is likely to be between $20 and $30 per session. The rest of the fee will then be covered by the insurance provider.
This offers a significant discount, as a single session of therapy can cost between $60 and $200 (and potentially even more).
This copay amount is hugely variable.
Who your insurance provider is, and who your therapist is, will both affect how much is expected as copay.
In some cases, the copay might be as low as just a few dollars. But in areas with a high cost of living, the copay might be upwards of $50.
How Much Is Therapy With An Out-Of-Network Therapist?
If you choose to see a therapist from outside your insurance provider’s network, then you may still be able to claim part of the cost on insurance.
However, for going out-of-network, you’ll be expected to cover more of the costs. The therapists within an insurance provider network have been vetted and approved by the insurance panel.
They have an easier route for reimbursement, and the insurance provider has easy access when making a claim.
If you visit a therapist in the provider’s network, the provider should cover a significant percentage of the fee.
However, depending on your issue, location, or working hours, you might not be able to see a therapist covered by your network.
In this case, you might feel you have to choose between seeing a less appropriate therapist, or covering the entire bill yourself.
Some insurance providers will reimburse part of the fee for an out-of-network therapist.
The percentage reimbursed is likely to be significantly less than an in-network therapist, but it does help cover costs. If you plan on visiting an out-of-network therapist, then speak to your insurance provider about options.
They can provide you with the exact details of what they can cover.
Do You Need To Pay For Therapy With Insurance Upfront?
Insurance allows those who are struggling financially to access mental health services.
However, sometimes an insurance provider will require you to pay the entire cost of the service upfront, and then claim what you can later.
Exactly how the payment process works depends on the insurance provider and the therapist.
In some cases, you might be expected to pay for the bill, and apply for reimbursement from your insurance. Although you will get the money back, this can be a struggle if you can’t access the funds immediately.
During the initial consultation with a therapist, ask how the insurance process works, and what you’ll need to do. If the therapist isn’t sure, then contact your insurance provider directly.
How Much Does A Therapist Earn Through Insurance?
If you’re a therapist, deciding whether or not to accept insurance is one of the most important choices you have to make for your practice.
On the one hand, accepting insurance offers a steady stream of clients, and increases your visibility. On the other, insurance is difficult to deal with, and can limit your options.
But what about the financial side?
Joining an insurance panel has a huge effect on your finances—sometimes good, sometimes bad.
Regardless of what the client pays, the provider should still cover the complete cost of the session. However, you may be expected to lower your fees when joining an insurance panel.
Working with an insurance provider might mean you earn less money per session.
The advantage is, an insurance provider can offer a steady stream of clients.
Most insurance providers now cover mental health services, although the caveats in place can make it hard to access the money.
If you’re looking for a therapist who takes insurance, you can expect to pay $20-$30 per session, and the rest of the payment is the responsibility of the insurance provider.
But there are no easy answers when it comes to accessing therapy through insurance. How much you’re expected to pay will depend on your insurance provider and your therapist.
If you are thinking of starting therapy, and you want to know what your insurance provider can do, contact them directly.