“As I’ve gotten older, my fear of doctors has increased exponentially. It’s not because of blood, or shots, or anything that most people are fearful of when walking into a medical office. It’s because of the oh-so-unpredictable bill that I know I’ll receive in the mail three weeks later when my insurance inevitably fails to cover as much of the cost as I anticipated.”
It seems like we’ve all heard some version of this story before. And unfortunately, many people fear that they could receive similar “surprise bills” after therapy or a behavioral health appointment.
Navigating mental health benefits can be tricky, but it’s not impossible. When you’re trying to predict the cost of therapy, there are a few factors to consider: how you’re going to pay and the frequency you want to see a therapist. Let’s begin.
Using health insurance to pay for therapy
If you have health insurance, the first step to figuring out the cost of therapy is to take a good look at your insurance policy. You can call the customer service number on the back of your card to confirm your specific benefits. You can ask, “What are my behavioral health benefits?” to find out how much you would pay for a therapy session. A few common terms you might hear include:
What is a Deductible?
A deductible is how much you have to pay out-of-pocket before your insurance carrier starts paying. If you look at your insurance card, you’ll see a Member ID number somewhere on there. Usually, you can go to your insurance company’s website and sign up for an account (using your Member ID) where you can see your insurance plan details, including what your deductible is.
What is Coinsurance?
Coinsurance is usually found in the same online portal where you found your deductible. This will be a percentage, not a dollar amount. Your coinsurance is the amount you’re responsible for paying after the deductible has been met.
What is a Copay?
If you look at the front of your insurance card, you can probably see copay costs. For example, it may say, “Primary Care: $25, Specialist Care: $50”, etc. If it displays a dollar amount, it’s a copay.
A copay is a set amount you pay for an appointment, due at the time of service. In most cases, your copay will not apply towards your yearly deductible. And you will always owe the copay amount unless you hit your out-of-pocket maximum for the year. After hitting your out-of-pocket maximum, insurance will cover 100% of the costs of your covered benefits.
Other ways to pay for therapy
There are many options for you to pay for mental health care, outside of using health insurance benefits.
What is a Employee Assistance Program (EAP)?
Many employers offer support through Employee Assistance Programs (EAPs) that provide a range of health, financial and social support, including support for mental and substance use disorders. Contact your employer to see if they have an EAP program and what services are covered.
What is a Flexible Spending Account (FSA)?
If you have a health plan through your employer, you may be able to use a Flexible Spending Account (FSA). An FSA is an account that you put money into to pay for certain health care costs that are out-of-pocket. FSAs are tax-free, which means that no taxes are paid on the money put into an FSA.
What is a Health Savings Account (HSA)?
If you have a high deductible health plan (HDHP), a Health Savings Account (HSA) is an account that lets you set money aside to pay for certain eligible health costs. The money set aside is not taxed, helping lower your overall health care costs.
What is Self-pay?
Many therapists offer affordable self-pay rates or sliding fee scales to help clients get the care they need, with or without using insurance benefits. When looking for a therapist, you can ask if they offer self-pay rates.
Know what’s covered in your treatment plan
The cost of your therapy session depends on your payment method and the behavioral health coverage provided by your insurance or EAP. Contact your insurance provider or employer to understand your behavioral health benefits and what is covered or not covered.
If you do not have health insurance coverage, or plan to use an HSA, FSA, or self-pay, contact your therapist directly to get a better understanding of their rates before your first session.
Your therapist will be able to determine a treatment plan that is right for your needs and your budget. They will help you better understand the specific costs and benefits of your treatment plan so that you know what’s covered and what you will need to pay.
Browse these articles to learn more about insurance benefits and other ways to pay for mental healthcare.
- What You Should Know About Your Insurance’s Mental Health Benefits
- Employee Assistance Program (EAP): What it is and why you should care
- Co-what? Understanding Your Copay and Coinsurance
- Healthcare Insurance Acronyms: HMO, PPO, EPO, POS
- SonderMind’s Healthcare Insurance Dictionary
If you or a loved one are experiencing a mental health emergency, do not use this site. Instead, call 911 or use one of these emergency resources.