How to Use Insurance for Therapy
Starting this blog right away with: the US healthcare system is so shitty. Insurance is a hit-or-miss (usually a miss!), and often people are without insurance as it’s usually not financially accessible. For mental health needs, insurance continues to fall through as well. The goal and fight will always be for universal healthcare, but as we try to survive in this violent, uncaring system, here is general information and resources in using your insurance and/or finding affordable options for therapy.
Using Insurance for Therapy
Insurance is so incredibly frustrating, and I’m not going to sugarcoat the process, it may take a lot of time on the phone talking to representatives. But If we’re already paying for insurance, the mentality is to at least reap some benefits, right? *Disclaimer that I’m not an insurance expert! These are just the common questions that clients have had about insurance! I always recommend that if you have the capacity, to do your research!
First thing that would be helpful to know is: Do you have an HMO or PPO? You can check this on your health insurance card/app/portal.
HMO
HMOs are health maintenance organizations. If you have an HMO, you have access to a specific network of providers who take your insurance. To see a specialist, you’ll need a referral from your general doctor (usually stated on your health insurance card). They are also usually cheaper than PPOs.If you have an HMO, you’d only be filtering for providers who accept your insurance. You can use different directories to do so, whether that be online or directly through your insurance. I’ve also listed a few below:
If you’ve found someone who’s a good fit but doesn’t take your specific insurance, you may be able to ask your insurance for a single-case agreement. This process is one that you’d take an active role in and would need the collaboration from your therapist, if they do offer that.
PPO
PPOs are preferred provider organizations, and they are usually more expensive. However, you have access to a larger network of providers, and you also have the option to see providers outside of your network and also without a referral.
If you have a PPO, you can also still find providers who directly accept your insurance. If you’d like to work with a therapist who does not take your insurance, you will usually ask your provider for a superbill!
Superbill
So, what the f*ck is a superbill, and how do you use it? A superbill is a document with ALL the information about the services you received (i.e. service code, your personal information, how much you paid for the services, etc). It is the document you submit as a claim to your insurance company. Working with an out-of-network therapist providing a superbill, the process includes paying out of pocket for sessions, receiving a superbill, submitting the claim/superbill to your insurance, and then getting reimbursed by your insurance for however much they cover.
Many more inclusive therapists / therapy practices are out of network from insurance companies, and thus offer superbills if you’re looking to use your insurance. (I will be discussing the nuances of insurance for mental health resources later on!)
Here are common questions you can ask to confirm your benefits when calling your insurance company:
Do I have mental health or behavioral health out-of-network benefits?
What is my deductible? Has it been met?
Is approval required by my primary care physician?
How many mental health sessions does my plan cover?
How do I obtain reimbursement for an out-of-network mental health provider?
My therapist's fees for sessions range from $$$ - $$$. How much would be covered per session?
Will sessions with a registered associate therapist (AMFT, ACSW, APCC) be covered?
Affordable Care (for those without insurance)
Again, the US sucks!! For those without insurance or with lack of mental healthcare benefits, here are a few resources!
Most therapists will have a certain percentage of their caseload open for sliding scale options, which can range in fees. You can use the same sites listed above to filter for sliding scale fees based on your sustainability.
Here are also other links to do so or have lower fees/free options:
Open Path Collective is a directory of different providers who offer fees from $30 - $60.
Entwine Community offers accessible mental health & support services for Asian American & multicultural individuals, families, and communities.
Loveland Therapy Fund offers Black women and girls financial assistance to begin therapy.
Mental Health Liberation offers free therapy services for Black, Indigenous and Communities of Color. You can sign up to hear about when they’re opening their next cycle.
*Therapy Acess Project: I’m adding this resource for LGBTQIA+ and BIPOC communities! This nonprofit will help to find therapy options that find your needs!
This is definitely a very brief explanation for some aspects of insurance, and unfortunately, there is likely more we’ll all have to tackle and navigate in our healthcare system. Hopefully, though this brings some clarity and makes the process of finding a therapist a little less daunting.