Navigating Insurance Coverage For Mental Health Treatment

A traumatic event, cumulative effects of life stress or an acute mental health incident—whatever the reason you’re seeking mental health help today, we’re here for you. One of the most common questions clients ask our counselors at the Mental Health Hotline is how much the treatment will cost.

We get it—medical care is expensive, and the worry about how you’re going to pay for the counseling and other care you need may seem like a huge barrier for many people. Our client intake representatives help you learn what your insurance covers and explore other payment options.

Does Health Insurance Cover a Mental Health Care Plan?

Yes, many plans do. If you have comprehensive health insurance, either through your employer or one you purchased on your own, you likely have coverage for some mental health services. What, specifically, and how much depends on your insurance carrier and plan—each is different.

But does your insurance cover psychiatrist visits and sessions with other mental health providers? The best place to start is to talk to your insurance carrier’s member services department. These representatives can explain your plan, find psychiatrists and therapists in your network and advise you of your coverage limits. Your member services agent can also tell you what, if any, type of psychiatric medicines are covered under your plan and whether generics as well as brand name medications are included.

Phew! That’s a lot to wade through, especially when you’re probably feeling depressed, anxious or stressed.

Luckily, many intake counselors at mental health clinics also process insurance for clients, so someone at your preferred facility can run your insurance and tell you exactly what your plan covers and what kind of co-pays and coinsurance costs you’re looking at.

Make the Most of Your Insurance Coverage for Mental Health Services

Some insurance companies may not cover mental health treatments unless “medically necessary.” This is why it’s so important to have a diagnosis from a Licensed Mental Health Professional (LMHP). Once you have a diagnosis, any medication, therapy or other services can be considered medically necessary.

However, not everyone needing mental health services has a diagnosable medical condition. Some people may need a counselor to help them through a traumatic event, like the death of a loved one, or to manage a transition in life, like going to college or getting divorced.

Your plan could cover counseling sessions, too, but may limit how many it covers each year.

You should know a few other things about your health plan:

What is your policy limit?
What is the co-pay structure for a specialist? Some plans consider mental health providers as specialist care and thus have higher co-pays.
Do you need pre-authorization from a primary care physician before seeing a mental health provider?
How will your benefits be paid? Do you submit a claim and get reimbursed, or does the provider bill your insurance carrier directly?
What services are considered medically necessary?

Some people may qualify for coverage for an extended inpatient stay, while others may only qualify for outpatient treatment. Working with your doctor or psychiatrist can help you establish that their recommended course of treatment is medically necessary.

Noninsurance Payment Options for Mental Health Services

Not everyone has insurance that covers therapy. Some people may have only a basic health insurance plan (or none). This doesn’t mean you can’t get the help you need—there are other options, such as:

Ask your therapist about sliding scale payments. Some counselors will adjust their rates based on your income.
Seek out a professional organization in your area. For example, the American Psychiatric Association (APA) has separate state associations that can connect people seeking mental health treatment with providers offering low-cost or free services.
Contact your city’s Health Department and ask about outreach services in your community. Many agencies have help for people in crisis.