Understanding Health Insurance & Payment Options
Health insurance can make therapy more accessible, but it can also feel confusing. This guide explains common insurance terms and how coverage typically works for mental health services.
Every insurance plan is different. The best way to understand your coverage is to contact your insurance provider directly and ask about your specific benefits.
Using Insurance for Therapy
Insurance is accepted for:
- Individual counseling sessions
- Some clinical group therapy sessions
Insurance is not accepted for:
- Intensive sessions
- Workshops
- Non-clinical group programs
These services are private pay only. A superbill may be available upon request if you would like to seek possible out-of-network reimbursement from your insurance company.
What You May Owe When Using Insurance
Using insurance does not necessarily mean therapy is fully covered. Your out-of-pocket cost depends on your specific plan and several key terms.
The full fee for individual counseling is $200 per session.
When using insurance, a pre-negotiated contracted rate applies. This rate varies by insurance company and plan.
Copay
A copay is a fixed amount you pay at each session.
Example: If your copay is $30, you will pay $30 per session regardless of the contracted rate.
Deductible
A deductible is the amount you must pay out of pocket before your insurance begins covering services. If your deductible has not been met, you may be responsible for the full contracted rate until that amount is reached. Most insurance plans reset deductibles annually, which means your out-of-pocket responsibility starts over at the beginning of each calendar year.
Coinsurance
After your deductible is met, you may still share the cost of services.
Example: If your coinsurance is 20 percent and the contracted rate is $140, you would pay $28 and your insurance would cover the remaining amount.
How Insurance Billing Works
If you are using insurance:
- We bill your insurance company directly
- You are responsible for any portion your plan does not cover
- If a claim is denied, you are responsible for the full session fee
If you are paying out of pocket:
- Payment is due at the time of service
- A superbill can be provided for possible reimbursement
What Is a Superbill?
A superbill is a detailed receipt that includes the information your insurance company requires to process an out-of-network reimbursement claim.
If you pay privately, you may submit this document to your insurance provider to request partial reimbursement, depending on your plan’s out-of-network benefits.
Reimbursement is not guaranteed and depends on your specific insurance policy.
Employee Assistance Programs (EAP)
We work with select Employee Assistance Programs on a case-by-case basis.
EAP benefits typically cover a limited number of sessions. If you would like to continue therapy after your EAP sessions end, we will discuss next steps and payment options at that time.
Charity-Sponsored Counseling
If your sessions are being funded by a nonprofit organization, religious group or community agency, payment arrangements must be coordinated in advance.
Retroactive billing adjustments or discounts are not available.
Tax Deductibility
In some cases, counseling services may qualify as a deductible medical expense under IRS guidelines. To qualify, you must itemize deductions and your total unreimbursed medical expenses must exceed 7.5 percent of your adjusted gross income.
Please consult a qualified tax professional to determine your eligibility.
Choosing Private Pay
Some clients choose to pay privately even if insurance is accepted.
Reasons may include:
- Greater privacy
- Fewer administrative restrictions
- Predictable session costs
When insurance is used, certain information such as a mental health diagnosis may be shared with the insurance provider as part of the billing process.
Private pay allows you to maintain greater control over your treatment and avoids potential insurance limitations such as session caps, coverage changes or claim denials.
