Does insurance cover therapy or rehab? If you’re wondering if your health care benefits include treatment for mental health conditions, you’re not alone. Figuring out what your benefits actually cover can feel overwhelming — especially if you’re already struggling with anxiety or other symptoms. The idea of piles of insurance-related paperwork could seem like the proverbial last straw. However, using your insurance to cover mental health treatment might be easier than you think.
Here’s the good news: Any plan purchased through the Health Insurance Marketplace is required to include benefits for mental health and substance abuse treatment. Most employer-sponsored plans — the ones you get through your job — include such benefits too.
In this guide, we’ll walk you through learning more about your mental health benefits, finding an in-network provider and using your insurance to help pay for therapy or rehab.
Understanding Your Mental Health Benefits and Whether Your Insurance Covers Therapy
Around 75% of Americans who have insurance say they found it fairly easy to get mental health care. That’s encouraging news and a good anecdotal answer to questions about whether insurance covers rehab.
To understand how your individual rehab or therapy insurance might work, you’ll need to check your plan’s summary of benefits. You may have been provided with a benefits booklet when you signed up for your plan. Many insurance providers today also manage online benefits portals; check your insurance card and paperwork for information about how to sign up for a portal.
As you sort through benefits paperwork or access your portal, look for terms like behavioral health, therapy or substance abuse treatment to find relevant benefits. You can also call the number on your insurance card and ask for help understanding your mental health benefits.
How to Find In-Network Providers
Once you understand what your plan covers, the next step is finding a provider that takes your insurance. Here’s how to get started, step by step:
- Log in to your insurance portal or navigate to your provider’s website. Look for a “Find a Provider” option.
- Filter your search. Most insurance providers let you filter by location, specialty and whether providers are in or out of network. For example, you might look for a substance abuse rehab in your county that’s also in network with your plan.
- Double-check with the provider. When you contact a potential provider, ask if they still take your insurance. It’s a good idea to double-check that the information listed in your benefits documents is up to date.
- Call your insurance company for help. If you don’t have luck finding a provider via your insurance company’s DIY tools, call the benefits or customer service hotline on your insurance card for assistance.
You can also ask your existing medical provider for referrals. For example, you might let your primary care physician know you’re struggling with anxiety and interested in therapy but need assistance via a referral to someone who’s in network with your insurance.
Pre-Authorizations and Common Hurdles
Before you book your first appointment, check if your insurance plan requires pre-authorization for mental health services. Some plans have to approve certain services before they cover them, and that might include therapy or inpatient rehab. If you skip this step, you could end up with a surprise bill.
Another common hurdle is session limits. Your plan might only cover a certain number of visits per year unless your provider submits documentation that demonstrates a medical requirement for more.
And finally, be prepared for a little back-and-forth. Mental health claims sometimes get flagged or delayed, even when everything’s in order. Keeping good notes and asking questions can help you stay ahead of the curve. Most mental health providers understand the steps required and do a lot of the heavy lifting for you.
Out-of-Pocket Costs and Using HSA/FSA
Even with insurance, you’ll likely have some out-of-pocket costs. These might include co-pays, deductibles or coinsurance. The exact amount depends on your plan and whether the provider is in-network.
One way to manage those costs is by using a health savings account (HSA) or flexible spending account (FSA). Both let you set aside money tax-free for eligible medical expenses — including therapy or rehab.
It’s tempting to avoid discussions about cost altogether if you’re already stressed and dealing with a mental health or substance abuse issue. However, going into treatment with all the facts can actually help increase your overall peace of mind. Talk to providers about your potential out-of-pocket costs — they’ll do an insurance verification and let you know what type of deductible and co-pay you might deal with. Many providers also offer flexible payment options for out-of-pocket costs.
Tips for Appealing Insurance Denials
If your insurance denies coverage for therapy or rehab, don’t panic — it happens more often than you’d think. Most mental health providers are familiar with the appeals process and can help you navigate it.
To support the appeal, you can:
- Ask your provider to write a letter of medical necessity if they haven’t already.
- Collect documentation that shows why treatment is needed.
- Keep a copy of the denial letter and any correspondence.
- Call your insurance company to ask about the appeals timeline and steps.
Get Help Finding Mental Health Resources That Work for You
Insurance can feel like a maze, but you don’t have to navigate it alone. Whether you’re just starting the process of finding in-network mental health providers or stuck somewhere along the way, support is available.
Contact the Mental Health Hotline for help finding local and regional mental health and rehab services. We’re here 24-7 to help you take the next step toward feeling better.
