You want to talk to someone. You’ve heard it costs a lot, and there are tons of hurdles. We’re here to help you navigate your options.
Are you looking for a peer who understands your situation because they’ve been there too? A psychologist? A psychiatrist? What’s the difference? And how do you know if your insurance will cover it? Use the jump-list of topics, or browse to find simplified answers to your questions, below.
Using Insurance To Get Mental Healthcare
- Mental healthcare and insurance: an overview
- Mini-glossary of insurance terms
- How to determine your mental health coverage
- Finding a covered mental health provider
- Figuring out what you want from a provider
- Questions to ask your potential provider
- How billing works for in-network mental health care
- How to get reimbursed for out-of-network mental healthcare (the dreaded superbill…)
- Getting mental healthcare on behalf of your dependent
- Medicaid/Medicare coverage for mental health
- How to ensure you get quality care
No-Insurance Alternatives For Getting Help
- Self-help books and guides
- Online interventions
- Free clinics and low-cost providers
- University training clinics
- Employee assistance programs
- Research studies
- Community support groups
Using Insurance To Get Mental Healthcare
Mental health care is hard to come by in the United States. Good mental health care is even rarer. Unfortunately, there is currently a shortage of MH professionals across the board. Many U.S. counties have few or no professionals available, and many of the professionals that are available have full caseloads.
Those who do find access to mental health care often find themselves jumping through insurance hurdles to start and continue their care. Many are surprised with denied claims and large bills. Because of the abundance of insurance options out there, and the variation in coverage among them, it’s a messy system. Here, we’ll help you navigate it.
Mini-glossary of insurance terms
Here is a short glossary of terms that may be useful in understanding your health care coverage.
Allowed amount — the maximum amount that an insurer will pay for a given service
Brand name — medications that are sold under a specific name and are patented, and usually cost more
Claim — a request for your insurance to cover some or all of the cost of the service accessed
Coinsurance — the percent of the total cost that you are responsible for paying, usually after you’ve met your deductible
Copayment — a fixed amount that you pay each time you access a particular service
Deductible — if you access any care, you’ll be responsible for paying 100% of the allowed amount for the service until you’ve reached the deductible amount, at which point your insurance begins to pay
Generic — medications that have the same exact ingredients as their brand name counterparts, but usually cost less
In network — providers within your insurance plan’s network, which will usually cost less for you
Out of network — some plans allow providers outside of your insurance plan’s network, which are partially covered, but will usually cost more for you
Preauthorization — for some care options and medications, your insurance needs to issue an approval before you can access the service
Premium — you or your employer will pay this amount for your insurance regardless of what services you use
Referral — a request by your primary care provider on your behalf for a specialist service, which is sometimes needed to access certain types of care
Bonus: What’s the difference between a psychiatrist and a psychologist?
There is a great full article on the differences, here. In short, remember that both can diagnose mental health conditions, and both can provide treatment; however, psychiatrists can prescribe medications and often don’t have much time to talk, while psychologists offer counseling and other behavioral interventions, as well as psychological testing.
How to know if your insurance covers mental health
Traditional mental health care rests in the hands of psychologists, therapists, and psychiatrists. Typically, this type of care will require insurance to be affordable. Below, we answer common questions about accessing and affording mental health care. First, you probably want to know what kind of care will be covered for you.
If you have an insurance plan, look on your insurer’s website to find a coverage sheet. There, you should be able to find information about in- and out-of-network coverage, copays, deductibles, and more.
Unfortunately, interpreting this information can be difficult. On the back of your insurance card, you should see phone numbers for different kinds of care. Reach out to the number associated with MH care (or general care) and ask them to walk you through their specific coverage.
A good rule of thumb is that if you’re covered for medical care, you can use that coverage to see a Psychiatrist – who is a type of specialist MD. If your plan offers separate coverage for counseling and mental health, therapy visits may be covered as well.
For those who know they don’t have good mental health coverage, you may want to skip to our section on getting help without mental health insurance.
Specific questions you might want to ask:
- Which mental health services does my plan cover?
- Does my plan cover both psychiatrist and psychologist/therapist visits?
- How much is my deductible for in-network mental health care?
- How much of my deductible have I already met?
- How much is the copayment for in-network mental health care?
- Is there a limit on how much I have to pay out-of-pocket per year?
- Is there a limit on how many sessions are covered per year?
- Do I need preauthorization or a referral to access mental health care?
- Is [specific provider] covered by my plan?
When you do eventually select a provider, double check with their office (not just the insurance company) to make sure you’re covered. You don’t want a surprise bill for a service you think is covered, but really isn’t. A provider should be able to clearly tell you what kind of coverage you’ll have for their help.
Finding a covered provider
Check Psychology Today’s find a therapist tool to see providers in your area. You can also select the dropdown box that says “therapist” to change your search to psychiatrists, treatment centers, and support groups. After submitting your search, you can select the “insurance” button to narrow the results by your plan.
Not every provider will be on the Psychology Today website. Also try the American Psychological Association’s search tool.
Many health insurance plans also include a doctor search tool in the patient portal. This may simplify the process of finding a clinician who actually accepts your coverage.
Figuring out what you want from a provider
So you found a few mental health providers near you who might be a good fit. After narrowing down a few good candidates, you’ll want to check in with yourself about important traits in a provider. This person will be your partner and advocate in healing, and you might want to ask yourself the following:
- How accessible do I need them to be? Do they invite clients to text or call during crises? Do I want someone with flexible scheduling, or a fixed weekly time slot?
- Do I have transportation to their office? Do they offer video visits or telehealth?
- Will they submit to insurance for me, or do I have to prepare and/or submit a superbill?
- Does the provider’s gender or sexual identity matter to me?
- Do I have a unique situation I need the provider to have experience with?
- What do I want from therapy? Do I prefer when someone listens quietly, or when someone takes a more active role in helping?
Questions to ask your potential provider
No two providers are alike. Here’s a list of questions you can ask your potential provider to help determine if they’ll be a good fit for you.
- What is your treatment orientation?
- Cognitive behavioral, psychodynamic, eclectic, etc
- What are your areas of expertise?
- What is your approach to therapy?
- How would we decide on treatment goals?
- What does a typical session look like?
- What kind of homework would I do after sessions, if any?
- Do you have experience with [my specific situation]?
- Specific problems or disorders, race/cultural issues, LGBT issues, etc.
- Are you more directive or reflective?
- Do you tend to see patients short-term or long-term?
- How often do you usually see patients?
- Do you accept [insurance plan]?
- Do you think we are a good fit?
How billing works for in-network care
If your insurance covers therapy or psychiatry, you’ll be eligible for in-network care. For in-network care, you’ll directly pay your provider the copay (or the full allowed amount until you meet your deductible) at each session. Your provider will then bill your insurance for the rest of their payment.
You shouldn’t have to do anything for the billing process, but it’s a good idea to keep an eye out for denied coverage or other issues with your insurance’s payment.
How to get reimbursed for out-of-network mental healthcare (the dreaded superbill…)
If you are seeing an out-of-network provider, and you have out-of-network benefits, you’ll likely need to submit superbills for your sessions. In this situation, you pay your provider directly and in full, and then after submitting a superbill, you’ll get reimbursed by your insurance. Sometimes the provider can submit the superbills for you, but you’ll likely need to do it yourself. A full guide to getting reimbursed can be found here, or see a checklist for creating your own super bill, below.
Creating your own therapy super bill
To create a superbill, search for a template or make your own. If you’re making your own, you’ll need the following information:
- Identifying information: Your name, date of birth, address, phone number, and any other information the insurer requires.
- Practice information: The name of the practice where you receive services, the office address, and any other identifying information the insurer routinely requests (e.g. EIN, NPI, and/or license number of the therapist).
- Referrer identification: If a medical provider referred you to your therapist, include the referring provider’s information and address, as well as their National Provider Identification (NPI) number. If you don’t know this number, ask the provider who referred you.
- ICD code: Your ICD code identifies your mental health diagnosis. If you don’t know your ICD code, ask your therapist.
- Date of service: The month, day, and year of your visit.
- CPT code: Your CPT code identifies which treatment procedures you have received. If you don’t know your CPT code, ask your therapist.
- Description of service: The name of the service associated with the CPT code.
- Cost of service: What you paid your therapist for this visit.
- Place of service code: The type of location where you received services.
Again, a complete guide for filing a super bill can be found here.
Care on behalf of your dependent
What happens when you’re trying to get care for someone else, who is on your insurance plan? Talk to your insurance provider and your potential mental health care provider to make sure your child or spouse is actually covered under your plan.
The hard part comes in picking a therapist or psychiatrist on behalf of someone else. We don’t always fully understand our child’s or partner’s needs, even if we have their best interests at heart.
If you’re trying to help your partner, try to make it an open dialog and guide them, rather than take the lead. They may just need a push to explore options on their own.
Alternatively, to decide on the right kind of therapist for your child, ask the potential provider these questions:
- What kind of child-oriented training and experience do you have?
- How will we communicate about my child’s progress?
- How long should I expect my child to be in therapy with you?
- What are your thoughts on medication? (if applicable)
- What type of therapy do you use most?
- Play therapy, CBT, family therapy, etc.
Before taking your dependent to a therapist, make sure they understand what is going on. Talk with them beforehand to see if you can identify goals together. Ask them what they want out of therapy.
And if they don’t end up liking the therapist, listen to them. A substantial predictor of therapy success is the quality of the relationship between therapist and patient. If your child does not feel comfortable around their therapist, they likely will not benefit much from the sessions. Consider trying a few providers until your child finds a natural fit.
How to ensure you get quality mental health care
To make sure you’ll receive quality care from your provider, vet them thoroughly before beginning sessions. Ask them questions to determine if they have the right background and skillset to help you. See if they’ve worked with other patients who have similar experiences and concerns. Ask yourself if you felt comfortable and heard during your initial introduction to the provider.
If you’re already in therapy, and it isn’t going well, be honest with your therapist about your concerns. It can be uncomfortable to assert yourself, especially to a trained professional, but it is sometimes necessary in mental health care.
If your provider is making you feel uncomfortable, is using techniques that don’t work for you, or isn’t listening to you, tell them. See if you can explore solutions together to strengthen your patient-therapist relationship. Or, if you have a feeling it’s just not a good fit, find another provider.
For therapy to be beneficial, it’s essential for the patient and therapist to have a good relationship. Telling your therapist that it’s not working out can be particularly difficult, but they will understand. They, just like you, want you to receive the best care possible.
If you’d like insurance, but find it difficult to find a plan that works with your income, try applying for Medicaid or Medicare. Medicaid can help you pay for therapy if you have a low income, and Medicare can help if you are older or have a disability.
So far we’ve mainly discussed the process for accessing mental health care through insurance. Luckily, if you’re one of the five million-plus Americans who have recently lost employment-linked health coverage, there are still mental health options out there for quality care–no insurance required.
Self-help books and guides
Research comparing individuals that were assigned a self-help book with individuals receiving standard care has shown that self-help guides can be successful for mental health care.
Just be sure to choose one that is highly-rated, and ideally one with an evidence-based background, to make sure you’re getting a quality guide. Some of the books most highly rated by mental health care professionals are listed here and here.
Also, remember that using a self help guide doesn’t mean you’re admitting defeat; you’re taking charge of your own wellbeing and happiness. Take self help books with a grain of salt, and use them as they fit you. There should be no feelings of pressure involved; you’re doing this for yourself!
Nonprofit CIMHS has produced a free online therapy tool for depression, and Stony Brook’s Lab for Scalable Mental Health has produced free web-based interventions for children and teens. Smartphone apps that cover a range of mental health issues can be found here, many of which are free.
Free clinics and low-cost providers
Try these provider lookup tools to find free clinics and low-cost mental health providers near you:
University training clinics
The providers in university training clinics are graduate students studying psychology, who are supervised by advanced psychological professionals.
Training clinics usually have sliding-scale fees, so that no patient is paying more than they can afford to pay. These sessions tend to be much more affordable than traditional providers, especially if you don’t have insurance.
To find a university training clinic, search for universities near you and see if they have a graduate psychology program.
Employee assistance programs
EAPs are employer-provider services for staff within a company or organization. Many states require employers to provide these services.
For instance, California State Employees’ EAP program is “offered at no charge to the employee and provides a valuable resource for support and information during difficult times, as well as consultation on day-to-day concerns.”
While limited in terms of care options, EAPs work independently from insurance and are usually free. If you need short-term care, check your employer’s EAP program to see what kind of services are available for you.
Many EAP programs provide a certain number of free counseling sessions per year, along with other resources to help mental health indirectly, such as financial planning advice and “consultation on day-to-day concerns.”
Before interventions make their way to community providers, they have to be tested in a research setting. Many folks think of research trials as only medicine-related, but you can also join trials for free non-pharmaceutical treatments.
If you meet qualifying criteria, you can participate in research studies investigating novel therapies and treatment approaches. These will be free or even offer payment to incentivize participation! You can search for open studies on the NIH Clinical Trials website, or you can see if any research labs are recruiting by visiting college and university websites. To find these studies, search the clinical psychology faculty listing on the site, find the faculty’s lab page, and check there for any openings.
Online Peer Support Chats
If you’d like to chat with people who know what you’re going through, support groups are the way to go. Ideally, you want a support group where there’s no fear of judgment, and where you don’t have to jump through hoops to join.
One example is Supportiv, which provides on-demand, low-cost, and highly accessible mental health support for all mental health concerns. Supportiv has been featured by Men’s Health, Oprah Magazine, and as a winner in the 2019 South By Southwest Pitch competition.
The first 24 hours are free for anyone, and it’s a good place to go if you need to talk, but aren’t yet sure about using your insurance for clinical care.
We hope this guide has helped you find options for your mental health care. Best of luck to you on your mental health journey.