Many health insurance plans include benefits for behavioral health and mental health services. However, exactly what your plan covers depends on your specific insurance policy.

Two people with the same insurance company can have very different therapy benefits depending on their individual plan.

Your coverage may depend on:

• Your deductible

• Your copay

• Your coinsurance

• Your out of pocket maximum

• Whether your therapist is in network

• The type of therapy or service provided

• Whether your appointment is in person or through telehealth

• Your insurance company's authorization or medical necessity requirements

Because insurance plans vary, your insurance company is ultimately the best source for confirming your specific benefits.

An in network therapist has a contractual agreement with your insurance company and generally accepts the insurance company's negotiated rate for covered services.

When you see an in network therapist, your portion of the cost is generally determined by your insurance plan.

For example, your plan might require a $30 copay for a covered therapy appointment. Another plan might require you to meet a deductible before insurance begins paying toward therapy.

Being in network does not necessarily mean therapy is free. It means your insurance company's contracted benefits may apply to the service.

An out of network therapist does not have the same contractual agreement with your insurance company.

Some insurance plans provide out of network mental health benefits, while others do not.

If your plan includes out of network benefits, your insurance company may reimburse some of the cost of therapy after you meet certain requirements.

If you are considering using out of network benefits, I recommend contacting your insurance company before beginning treatment so you understand your expected responsibility.

Look at the back of your insurance card and be sure to call the number for “member services” or something similar. You will then follow prompts for “behavioral health”. When speaking to a live agent or AI assistant mention you are seeking individual therapy. The CPT Code will typically be 90837.

**Ask them “How much would a session be for 90837 Individual Therapy both in person and online?”

Before beginning therapy, you can call the member services number on the back of your insurance card and ask questions such as:

• Do I have outpatient mental health benefits?

• Is individual psychotherapy covered?

• Do I have a deductible for behavioral health services?

• Have I met my deductible?

• What is my copay for outpatient mental health therapy?

• Do I have coinsurance?

• What is my out of pocket maximum?

• Does my deductible apply to mental health services?

• Do I need prior authorization?

• Are there any limitations on the number of therapy sessions?

• Are telehealth appointments covered?

• Is Highway to Heal Counseling an in network provider for my specific plan?

A deductible is the amount you may have to pay toward covered healthcare services before your insurance begins contributing according to your plan's benefits.

For example, imagine your plan has a $1,500 deductible.

Depending on your plan, you may be responsible for the allowed cost of covered therapy services until you meet that deductible. MOST therapy is only a co-pay, but some plans require meeting a deductible first before insurance assists with payment. After that, your plan may begin covering a percentage of the allowed amount.

Paying down oyur deductible through therapy and/or other services (doctor visits, physical therapy, etc.) will help make all future medical services for the year more affordable.

Not every health plan applies deductibles to therapy in the same way, so check your specific benefits.

A copay is a set amount you pay for a covered healthcare service.

For example, your plan might have a $30 behavioral health copay.

If your plan applies a $30 copay to your therapy appointment, you would generally pay $30 for that covered service and your insurance company would pay the remaining allowed amount.

Your actual copay depends on your specific insurance plan.

Coinsurance is the percentage of a covered healthcare service that you are responsible for paying after applicable requirements, such as your deductible, have been met.

For example, if your plan requires 20% coinsurance, you may be responsible for 20% of the insurance company's allowed amount while your insurance covers the remaining 80%.

The actual amount depends on your plan's allowed amount and benefit structure.

Your out of pocket maximum is the most you are generally required to pay for covered in network healthcare services during your plan year, subject to the rules of your insurance plan.

Once you reach your applicable out of pocket maximum, your plan may cover additional covered in network services at 100% for the remainder of the plan year.

However, not every expense counts toward the out of pocket maximum, so it is important to review your specific plan.

One of the most confusing parts of using health insurance for therapy is discovering that your cost can change during the year.

This can happen when:

Your benefits reset

Many insurance plans have an annual benefit period. For some people, benefits reset on January 1. For others, the plan year follows a different schedule.

When your benefits reset, your deductible and other cost sharing requirements may start over.

You changed insurance plans

Starting a new job, changing employers, getting married, changing plans during open enrollment, or otherwise changing coverage can result in a completely different deductible, copay, coinsurance, or out of pocket maximum.

Your insurance company changed your benefits

Employers and insurance companies can make changes to plan benefits.

If something about your therapy cost suddenly changes, contact your insurance company and ask them to explain the change.

Your service or appointment type changed

Different behavioral health services can have different benefits. Generally, this change does not happen unless one swithces from online to in person (or vice versa) or changes from individual therapy to another form of therapy (i.e. couples therapy).

Telehealth and in person appointments may also be treated differently by some plans.

At the moment, we accept the following:

• Aetna

• Baylor Scott and White -Coming Soon

• Blue Cross Blue Shield (BCBS)

• Cigna

• United Healthcare / Optum / UMR

• Oscar Health

• Oxford

In that case, we can look at private pay options, which are $140 an hour. Sliding scale can be offered, if available, for a reducted rate to a limited amount of clients that have financial strains preventing affording the full hourly rate. Please contact for more information.

The one major benefit in not using insurance is there is more privacy for the client. Insurance requires a diagnosis and medical necessity to cover therapy as well as descriptive notes to justify their reimbursements. This is something to keep in mind when deciding for or against using insurance for therapy.