Deciding to seek therapy is a brave step forward in your mental health journey. The next step is deciding how to finance therapy sessions while still prioritizing your well-being.
Understandably, the very thought of financial stress from healthcare costs can compound mental health struggles. Thankfully, you can reduce your costs with several insurance tips and tricks, including in-network care, telehealth copays, superbills, HSAs and FSAs, employee assistance programs, Medicaid, claim appeals, and single case agreements.
1. Choose In-Network Care
First, see if there’s an in-network provider that offers the type of therapy you’re looking for, whether it’s art therapy, group sessions, or individual counseling. Mental health professionals who take in-network insurance accept pre-negotiated rates with the insurer. Therefore, you don’t have to pay the full private pay rate; instead, you would pay a standard copay or coinsurance amount after meeting your deductible.
2. Verify Your Benefits
Thoroughly review your insurance policy to see which type of therapy your plan covers. Mental health benefits can differ from general medical coverage. Call the member services line for your insurance policy and ask the following questions:
What is the deductible for outpatient mental health treatment, and has that amount been met?
What is the exact copay or coinsurance rate for a therapy session?
Is there a limit on the number of appointments per year?
Do sessions have to be pre-authorized first?
When verifying benefits, check to see if you have any unclaimed life insurance benefits as a policy beneficiary, as these funds could go toward out-of-pocket expenses for mental health treatment. Insurance regulatory compliance also mandates that life insurance companies inform beneficiaries of unclaimed benefits.
3. Check Telehealth Copays
Virtual therapy is another accessible option. Verify if your insurer covers this service. They may be covered in combination with in-person sessions, even with lower copays, depending on your state.
Many insurers cover telehealth services at reduced rates to encourage virtual care. There are also online therapy platforms that connect users with therapists, where you can find low private rates or monthly subscriptions.
4. Request a Superbill for Out-of-Network Care
The right therapist for your needs may be out-of-network, but this doesn’t mean you have to pay the full amount per session. See if they’re willing to provide a superbill, which is an itemized receipt with clinical details and diagnostic (ICD-10) and service codes (CPT). If your health insurance does cover out-of-network therapy, you can submit a superbill to the insurance company for partial reimbursement.
5. Use HSA or FSA Funds
If you have a Health Savings Account (HSA) or a Flexible Spending Account (FSA) through an employer, you can use these pre-tax funds to pay for your therapy. Therapy copays, deductibles, and out-of-network costs all qualify as eligible medical expenses for these accounts. Employers can also make tax-free contributions to your HSA, essentially giving you a discount on therapy.
6. Leverage Employer EAP Sessions
Does your work benefits package include an Employee Assistance Program?
There’s a good chance your EAP offers a few short-term therapy sessions. These sessions are free, but you should take advantage of them by the end of the year, as they don’t roll over. Since these sessions are separate from standard insurance benefits, you don’t have to pay out-of-pocket expenses.
Employees often use these sessions for managing stressful life transitions and short-term mental health struggles.
7. Explore Medicaid Options
See if your annual income qualifies you for the federally funded Medicaid program. You may also be eligible for Medicaid if you’re experiencing sudden or prolonged financial hardship.
By law, this program must provide essential general health care, including access to mental health services. Therapy costs vary by state under Medicaid, but out-of-pocket costs are generally low or even free.
8. Appeal Insurance Claim Denials
An insurance provider can deny a claim for a variety of reasons, including missing or incorrect policy information.
Always appeal a denied claim. Your therapist can help you file a formal appeal, provide progress notes, and write a letter explaining the medical necessity of your therapy. With a provider involved, the chances of your claim denial being overturned are much higher.
9. Request a Single Case Agreement (SCA)
If you need a specialized type of therapy, like therapy for a traumatic experience or health crisis, you may need to go out of your network to find the right professional.
In these cases, you can request a Single Case Agreement. An SCA is a contract between you and your health insurance company that agrees to cover your out-of-network therapy at an in-network rate. An insurer would approve the SCA if there are no suitable in-network services for your case.
Get the Care You Need
Explore your in-network and out-of-network options to find the right professional for this chapter in your life. Understand your insurance policies inside and out to keep your costs low, as well as EAPs, SCAs, HSAs, FSAs, and federal programs if you qualify.
Follow our blog to learn more about mental health care, from booking your first appointment to healthy habit changes to improve well-being.
