How to Find Out if Your Health Insurance Will Cover Therapy
Does health insurance cover therapy?
Do you think your insurance covers therapy? You may be surprised to learn that many insurance plans are quite limited in what they will pay for. If you have a high-deductible plan or any other type of plan that doesn’t seem to offer much coverage, it might not include the cost of therapy. And unfortunately, it’s not always obvious if your health insurance will cover therapy. Luckily, there are some simple steps you can take to find out exactly what your insurance covers and whether it includes therapy services. If you have purchased an Affordable Care Act (ACA) plan through the Health Insurance Marketplace or another type of private health insurance program, you might be wondering if that policy includes coverage for mental health services like therapy. While the ACA does require all individual and small business plans to offer some level of mental health benefits, not every policy covers the same services and therapies. Here’s how to discover if yours does.
Check Your Health Plan’s Benefits
Every insurance plan is different and offers different coverage. In general, it’s a good first step to determine what your specific plan covers regarding mental health care. If you have an employer-based health plan, you can ask your human resources department for your plan’s policy details. If you have an individual plan purchased through the Health Insurance Marketplace, you can find your plan’s benefits listed on your Summary of Benefits and Coverage (SBC). Finding your plan’s benefits will give you a general idea of what is covered under your plan and what type of mental health services you can expect it to pay for. You can also look up your plan’s specific coverage on HealthCare.gov or use their Health Plan Finder tool.
Check Which Providers Are In-Network
While your plan’s benefits outline what services it covers, it’s also important to understand which specific providers are in-network and which are out-of-network. This is especially important when it comes to mental health and therapy services, as many plans require you to visit an in-network provider to receive coverage for these services. If a provider is out-of-network, your plan will typically only cover a percentage of the cost. Find out if your preferred therapist or mental health care provider is in-network under your health plan. If they’re not, you may still be able to visit them and pay out-of-pocket, or you may need to seek out an in-network provider. You can look up your plan’s in-network providers online (HealthCare.gov also provides this information). You can also speak with your health plan’s customer service team to ask if your preferred provider is in-network.
Check your Explanation of Benefits (EOB)
A less obvious way to find out if your health plan covers therapy is to examine your Explanation of Benefits (EOB) document. This document will outline what services your insurance paid for and which ones it didn’t. If your health plan does cover therapy, an EOB will detail what type of therapy services are included. For example, some plans may cover general talk therapy but not other types of mental health treatment like behavioral health therapy or medication. It’s important to look over your EOB to see what your plan covers, what isn’t covered, and why. You can access your EOB online through your insurance company’s website or via an app like Medavie Blue Cross Mobile App, or you can call or email your insurance company to request a copy.
Ask Your Provider or Plan If Therapists Are In-Network
Another way to find out if your health plan covers therapy is to ask your insurance company or your health plan’s customer service team if therapy is covered. If you have an individual plan, you can also ask your preferred mental health care provider if they’re in-network under your health plan. If a provider is in-network under your health plan, your insurance will cover a portion of the cost. However, if a provider isn’t in-network, your insurance will only cover a percentage of the cost, if any at all. If a provider isn’t in-network under your health plan, you may be able to visit them out of network and pay out-of-pocket, or you might need to seek out an in-network provider. While you can ask your insurance company or plan if therapy is covered, you may not get a clear answer.
Conclusion
While the Affordable Care Act does require health insurance plans to include mental health coverage, not all plans include therapy services. It is important to make sure your specific health plan covers therapy, and if it does, make sure to ask your health care provider if they are in-network with your plan. It may be a good idea to speak with your insurance company or plan’s customer service team to see if they can offer any guidance or information. If you’re looking for mental health care, it can be helpful to know ahead of time if your health insurance will cover therapy.
At Triton Health Plans, we do our best in making sure that our clients are well-protected with affordable and comprehensive policies. We make sure to go the extra mile to help you with your needs. To learn more about how we can help you, please contact us at (407) 501-1772 or Click Here to request a free quote or schedule an appointment.
