What Are the Costs of Therapy With Insurance? Key Things to Know
How to Check the Cost of Therapy With Your Insurance Plan
Health insurance can be confusing, especially when you're trying to figure out what therapy will cost with your insurance. If you're looking for clarity, keep reading to learn how to contact your insurance company and what key questions to ask about insurance coverage for therapy.
How to Find Contact Information for Your Insurance Company
You can usually find your insurance company’s customer service phone number on the back of your insurance card. This number is essential for calling to verify your insurance benefits, including coverage for services like therapy or mental health treatment.
Most insurance providers also offer an online member portal, accessible through their official website. These portals often allow you to log in and check your insurance coverage, view claims, and confirm your therapy benefits without needing to make a phone call.
How to Check If a Therapist Is In-Network with Your Health Insurance
When you contact your insurance company, be sure to ask whether the therapist you plan to see is in-network with your health insurance plan. An in-network therapist is one who accepts your insurance and can bill your insurance provider directly using in-network benefits.
You can also often look up your therapist on your insurance provider’s online member portal to check their network status. For example, if you have Blue Cross Blue Shield of Michigan, their website offers a “Find Care” tool where you can search for your therapist by name.
If the insurance representative tells you that the therapist is out-of-network, ask whether your plan includes out-of-network benefits. An out-of-network therapist is not contracted with your insurance provider. However, many therapists can still provide a superbill — a detailed receipt for therapy services — which you can submit to your insurance company for potential reimbursement under your out-of-network benefits.
Questions to Ask Your Health Insurance Company About Mental Health Coverage
When verifying your therapy benefits with your insurance provider, ask the following questions to fully understand your mental health coverage:
Is [Therapist’s Name] in-network with my insurance plan?
(Use the exact name listed on your provider’s website or directory.)If the therapist is out-of-network, what are my out-of-network mental health benefits?
Do I need to meet a deductible before insurance will reimburse for therapy sessions?
Are there any limitations or restrictions on what mental health services are reimbursed?
If the therapist is in-network, what are my in-network therapy benefits?
Do I need to meet my deductible before my copay or coinsurance applies?
What is the amount of my deductible? How much of it have I already met this year?
What is my copay or coinsurance amount per therapy session?
How to Verify Coverage for Specific Therapy Services
To better understand your mental health insurance coverage, it’s helpful to identify whether the specific therapy billing codes (also known as CPT codes) are covered by your insurance plan. These codes represent the exact services provided and are commonly used for verifying therapy benefits and calculating potential out-of-pocket costs.
At Create Wellness Counseling LLC, the following therapy CPT codes are most commonly used:
Initial Therapy Appointment
90791 – Psychotherapy Intake (Initial Diagnostic Evaluation)
Follow-Up Therapy Sessions
90837 – Individual Psychotherapy (53+ minutes)
90834 – Individual Psychotherapy (45 minutes)
90832 – Individual Psychotherapy (30 minutes)
Many insurance providers allow you to search these billing codes through their online member portals. For example, if you have Blue Cross Blue Shield of Michigan, you can use their “Procedure Cost Estimates” tool to look up these codes and see your estimated coverage, copay, or coinsurance.
Questions to Ask Your Health Insurance Company About Specific Therapy Services
Does my insurance cover the following CPT codes?
90791
90837
90834
90832
Does my insurance cover virtual therapy or Telehealth appointments?
At Create Wellness Counseling, Courtney currently offers therapy exclusively via Telehealth (virtual sessions). Verifying Telehealth coverage ensures you know whether these remote sessions are eligible for reimbursement under your current insurance policy.
Understanding and Identifying Your Out-of-Pocket Therapy Costs
Knowing whether you have in-network benefits—and understanding your copay, coinsurance, and deductible amounts—can help you estimate your out-of-pocket costs for therapy sessions covered by your insurance.
How Deductibles and Copays Work:
If your insurance plan includes a deductible, you may need to pay the full cost of therapy sessions until you meet that deductible before your copay or coinsurance applies. For example, if you have a $500 deductible and a $20 copay, you would pay the full session cost until you reach the $500 deductible. After that, your copay for each therapy session would be $20.
Keep in mind, some insurance policies exclude certain CPT codes or office visits from the deductible, meaning those services may be covered immediately without needing to meet the deductible first.
Questions to Ask Your Health Insurance Company About Copay and Deductible
Does My Insurance Deductible Apply to Psychotherapy Visits and [Insert CPT Billing Code]?
Therapy Options When using your Insurance Is Not Affordable
Depending on your insurance benefits, using your insurance for therapy may not always be the most affordable option. If you’re considering not using insurance due to cost concerns, here are some alternative resources to explore for lower-cost therapy:
Sliding Scale Therapy
Many therapists offer a sliding scale fee structure, where session costs are adjusted based on your income. Keep in mind that therapists often have a limited number of sliding scale slots available.
University and College Counseling Centers
Counseling programs at local universities and colleges frequently provide low-cost therapy services through their on-campus counseling centers. These sessions are typically conducted by student therapists supervised by licensed clinicians. Availability may be limited by the academic calendar.
Therapy Interns
Some therapy practices and organizations employ interns who offer therapy at reduced rates. These interns are usually completing their clinical training under the supervision of experienced, licensed therapists.
Open Path Collective
Open Path Collective is a nationwide nonprofit that connects clients to therapists offering sessions priced between $30 and $70. There is a one-time membership fee of $65 to access their directory of affordable therapists.
Free & Charitable Clinics of Michigan (FCOM)
The Free & Charitable Clinics of Michigan (FCOM) website provides a directory of clinics offering free or low-cost healthcare services, including mental health care, throughout Michigan.
Discuss Cost Concerns with your Mental Health Provider
If you have any questions or concerns about the cost of therapy, don’t hesitate to speak with your clinician. At Create Wellness Counseling, we will verify your insurance benefits after receiving your completed intake paperwork.
Please note, I won’t know exactly how much your insurance will cover until I file the first claim following your intake session. Insurance coverage can vary depending on your plan, deductible, and whether services are in-network or out-of-network.
While I will assist with verification, I strongly encourage you to contact your insurance provider directly to confirm your mental health benefits. As the policyholder, it is ultimately your responsibility to understand your coverage, including any copays, coinsurance, or deductibles that may apply.
