According to the electronic health record platform SimplePractice, the average cost of a session in the United States varies from $100 to $200. This article details ways to afford therapy, including getting reimbursed by your health insurance.
How Does Health Insurance Cover Therapy?
Until recently, many health insurance plans in the United States excluded coverage of mental health care. Even if someone had health insurance, their plan might exclude therapy services. However, an amendment to the Affordable Care Act known as the Mental Health Parity and Addiction Equity Act (MHPAEA) required insurance plans to cover mental health. Some insurance plans exclude certain diagnoses from coverage. For example, some plans do not cover adjustment disorders because these are considered short-term rather than chronic conditions.
Copays and Deductibles
Most mental health plans have either a copay or a deductible. If you have a copay plan, this means you pay a set amount each time you have an appointment. For example, if your plan’s copay is $40, you will pay $40 per session, and your insurance will cover the remainder of your balance. If you have a deductible plan, you pay the full cost of services out of pocket until your deductible is met, at which time your insurance will start covering a percentage of your costs. If your plan has a $3,500 deductible, you will pay $3,500 of all of your medical costs out of pocket before your insurance starts covering a portion of your sessions. If, for instance, your therapist charges $150 for a 45-minute session but has a negotiated rate with your insurance company of $120 per session, you would pay $120 per session until you reach your deductible.
What Types of Therapy Are Covered By Insurance?
When a therapist bills their sessions to insurance, they use Current Procedural Terminology (CPT) codes to indicate the type of session. Various codes are covered by different insurance plans, with some plans excluding certain codes. If you plan to use your insurance to cover your therapy costs, ask your provider what billing codes they use to code their sessions. Then, call your insurance’s customer service number and ask if your plan covers those billing codes. The most common CPT codes used for therapy are:
90791 “Psychiatric Diagnostic Evaluation.” Commonly referred to as an intake or diagnostic interview, this code is typically used in a first therapy session. During this appointment, the therapist will ask questions about history and symptoms, and they will determine whether you meet the DSM diagnostic criteria for a mental health diagnosis. 90837/90834/90832 “Psychotherapy.” These three codes indicate therapy sessions, and the code used depends on the length of the session. 90837 is called a one-hour appointment (a session lasting 53 minutes or more), 90834 is called a 45-minute appointment (a session must last 38-52 minutes to qualify for this billing code), and 90832 is called a 30-minute appointment (lasting 16-37 minutes). Many plans will not cover hour-long sessions. 90847/90846 “Family Psychotherapy.” 90847 refers to family therapy with the identified client present, and 90846 is family therapy without the client present (for instance, with a child client, a parenting skills session that the child does not attend). 90847 also includes couples therapy. Some plans only cover 90847 and not 90846, and others do not cover family psychotherapy at all. However, many plans will cover 90834 with a family member present. 90853 “Group Psychotherapy.” Group therapy specifically refers to groups of non-family members, such as a group for people coping with grief or a social skills group.
Paying For Therapy
Many electronic health records include a client portal where you can pay for sessions via credit or debit card, and providers often accept cash or check payments. You can use a health savings account to cover your out-of-pocket therapy costs. Applications for transferring money such as Venmo, PayPal, and CashApp are not HIPAA-compliant (meaning they do not meet federal standards for protecting your private healthcare information) and should not be used to pay for therapy. It is your provider’s responsibility to only accept HIPAA-compliant payment methods. If you have a high deductible plan, your therapist might allow you to set up a payment plan to pay down your balance after your insurance begins covering sessions. For example, if your deductible has you paying $100 per session and your deductible is $1,000, your therapist could agree for you to pay $50 per week until the deductible is paid off.
How to Get Reimbursed for Therapy
Some therapists do not accept insurance or only accept certain insurances. This is because billing insurance is time-consuming, companies often delay payment, and insurance companies can initiate “clawbacks” where they take back payment up to five years after service was provided. Some companies also limit how many providers can accept their insurance. Before a therapist can bill an insurance company, they must complete a credentialing application with that company. Essentially, they apply to be allowed to accept the insurance. If your therapist attempted to credential with your insurance company but was told their panel is full, you can call and request that they expand their panel if you were unable to find an in-network provider with availability to see you. If a therapist does not accept your insurance, they are considered out of network. You can request that your therapist put together a Super Bill or an invoice about the services you received and what you paid for them. A Super Bill requires that you pay for services first but you can submit it to your insurance company and potentially be reimbursed with some or all of your therapy costs.
If You Are Uninsured
If you do not have insurance, you might not be able to afford the out-of-pocket cost of therapy. Many therapists have sliding scale spots in their practice, which allow clients to pay for sessions based on their income or financial means. Many providers have information about sliding scale fees on their website, and Open Path Collective has resources for people seeking a therapist who offers sliding scale rates.
