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4 min read

Does insurance pay for therapy?

Williamsburg Therapy Group adults talking and smiling at eachother

Health insurance plans can be terribly confusing to navigate, especially when you need answers to specific questions. How much will I pay to see a doctor? Which prescriptions are covered by my health plan? Is my doctor considered in-network? Does insurance pay for therapy?

Every insurance company operates differently, and even plans within the same company will offer varying benefits. Knowing the ins and outs of one policy does not equate to knowing the exact specifications of another. No two companies are identical, and plans are diverse. 

While figuring out what your insurance plan does and does not cover may be a challenge, it is a critical step in determining whether your insurance covers therapy. 


Can You See a Therapist Using Insurance?


In the world of insurance, medical care is different from mental health care. Yes, that statement probably sounds silly, especially since a person’s physical and mental well-being are often directly connected.

So with that said, the type of coverage you have to treat a broken bone may vary from the kind of coverage you have to treat a mental health disorder. Your plan may cover all those sick visits to your child’s pediatrician, but that does not necessarily equate to a plan that extends the same coverage for sessions with a therapist. 

How can you find out if insurance will cover therapy, and if therapy is a covered service, how much will sessions cost? These two frequently-asked questions can be answered by looking at the parameters of your plan. 

Deductible
A deductible is a set out-of-pocket amount that must be met before an insurance company makes payments toward covered services. Deductible plans cover a certain percentage of the cost of services only after you have exceeded that deductible amount.

Co-Pay
A co-pay plan would mean you pay a predetermined amount for covered services. It is a flat fee paid by an insured, usually at the time of service. 

In-Network
Insurance companies contract with specific doctors, specialists, therapists, and other medical professionals to allow an insured to receive services at a prenegotiated rate. These in-network providers are often referred to as participating providers. 

Out-Of-Network
Providers that do not have a contract with your insurance company are referred to as out-of-network providers. When receiving care by an out-of-network provider, they are not bound to a predesignated price set forth by your insurance company.

In-Person
Some insurance companies only extend coverage if the doctor visit or therapy session takes place in-person. Even if a provider offers “virtual” appointments, that does not mean your plan covers such visits. 

TeleHealth
Remote healthcare services are increasing in popularity. But beware, some insurance plans still require an insured to receive face-to-face services.



Will Insurance Cover Therapy?


While there are general guidelines that apply to most insurance plans, the key is knowing which ones apply to your own policy. From there, you can determine what type of coverage is part of your plan and the amount you’ll pay for services from specific providers.

If you are having trouble answering the question does insurance pay for therapy, you can check your policy terms and coverage in a few simple steps.

Read the Summary of Benefits and Coverage (SBC)
An SBC lists the services covered by a plan. It is a summary of all costs, benefits, services, and features associated with a policy.

Create an Online Account
You can discover everything you want to know about your policy by creating an online account with your insurance company. Utilizing your online account is an excellent way to access the exact details of your plan.  

Search for a Particular Provider
Your insurance company can provide a list of providers that will accept your plan. In your online account, use the doctor search tool to check if a certain doctor or specialist is considered in-network or out-of-network. 

Call Your Insurance Company
If using an online account is not your cup of tea, make a phone call to your insurance company. Be prepared to provide your personal policy information, such as the policy number and group number associated with your plan. 

Verify Specific Billing Codes 
Billing codes identify the work performed by a provider. You can check if your insurance will cover therapy by asking if certain billing codes are covered under your plan. 

Check With Your Employer’s Human Resources (HR) Department 
If you receive insurance coverage through an employer’s plan, reach out to the HR department. Oftentimes, HR representatives know the details about the insurance plans offered by the employer.


Does Insurance Pay for Therapy at Williamsburg Therapy Group?


We are often asked the question, “Does insurance pay for therapy?”

Here at Williamsburg Therapy Group, our doctors are considered out-of-network providers. This is common for most high quality mental health providers, since contracting directly with insurance companies often creates substantial barriers for providers.  But this does not mean that your insurance company may not pay for the services you receive at Williamsburg Therapy Group.

While we do not accept insurance directly, we do provide our patients with two ways to obtain reimbursement, assuming you are eligible.  

  1. Check your eligibility through the Nirvana calculator.  Here you will discover if Nirvana can electronically submit claims on your behalf.  If this is the case, then Nirvana will automatically process everything for you.
  2. If you check and discover you are unable to file using Nirvana, dont worry, you may still be eligible for reimbursement but will need to check with your insurance company. 

Most people we encounter do have Out-of-Network benefits but strongly encourage you to contact your insurance company and ask the following questions:

  • Do I have out-of-network benefits for outpatient mental health?
  • If so, how much will I get reimbursed per session for a 45-50 minute session?
  • Do I have to meet a deductible before my out-of-network benefits kick in?
  • Am I eligible to use these benefits for telehealth and in-person appointments, or only in-person?
  • Do I need to be referred by an in-network provider, such as my PCP, in order to see an out-of-network therapist?

If you discover you do have Out-of-Network benefits but your insurance company is not yet contracted with Nirvana, it just means you may have to submit claims for reimbursement manually.  

We give our patients the necessary paperwork that they need to file a claim with their insurance company, and from there, many end up receiving a reimbursement for a portion of what they paid for therapy. 

We want to make the reimbursement process as easy as possible for our patients, and that’s why we have partnered with Nirvana. Nirvana plays an integral role in the reimbursement process for out-of-network claims.

We understand that finding the answer can be a challenge for many patients. Take a look at our Insurance & Therapy FAQ’s for more information about receiving therapy at the Williamsburg Therapy Group.  

 

 

 

How can we help you?  

We offer both individual and group therapies in NYC and Austin, TX.

 

 


 

MEET THE AUTHOR

WilliamsburgTherapyGroup-Jesse-Gomez

Jesse Gomez

Chief Revenue Officer

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