Will My Insurance Cover Counseling?
Update: This page has gotten A LOT of clicks from all over the world. Please note it is written with information about US based insurance.
Us therapists get this question A LOT. And my answer is a very unsatisfying “maybe??”. Insurance is a tricky thing especially with all the healthcare changes that seem to happen weekly. The best thing to do is to call your insurance company and ask a bunch of questions (they will not want to talk to me because of confidentiality). The number should be on the back of your card. Ask the following questions:
- Does my insurance cover mental health services? May be called behavioral health.
- Are there only certain diagnoses that are covered?
- Is there a limit to the number of sessions I am allowed? They are not supposed to do this in California but I have heard of it happening
- Will my insurance cover an out-of-network provider? (if yes) what % of the session fee will my insurance pay? Or what $ amount is paid per session. (Our typical CPT codes are 90791, 90834, or 90837 for individual therapy and 90847 for family)
- Do I need an authorization number for out-of-network? (If yes) How do I get an authorization number?
- Will my insurance automatically cover telehealth therapy? In California insurance is required to cover telehealth at the same rate as in office. But an out of state insurance company may not know this. Better to get clarity upfront.
- If I submit a superbill (document I give you to turn into your insurance company) how long will it take for me to get paid?
Oh and do not forget to write down the answers to tell me (or whatever therapist you choose).
How does this apply to therapy with Kelly Burris? Well…. I am an out-of-network provider. If your insurance will cover an out-of-network therapist then you will definitely want to know the % of cost insurance will cover so we can estimate your final expense.
Example:
Your insurance will cover 70% for 12 sessions. For an individual 50 minute session I charge $250. You would pay the $250 at the start of session. We would have our session. Then you would submit the information to your insurance on a “Superbill” form I provide to you. If everything goes according to plan your insurance would mail you a check for $175 (70% of $250). If you are limited to 12 out-of-network sessions then this could be done 12 times.
This does not always work perfectly. Insurance is in the business of making money; that is why we want all the information upfront to increase the chance of you receiving your reimbursement check as expected from your insurance. If something does go wrong you can call insurance to try to sort it out. If insurance does not reimburse as you expected I do not offer refunds on the amount paid to me for services. I encourage people to think for an insurance reimbursement as a “hopefully” because the money is not always sent by your insurance as expected or in a timely manner.
I hope that isn’t too frustrating to read! I just want to make sure I am being open and realistic about what to expect from insurance reimbursement when seeing an out-of-network provider. I will always help you submit your claim in a timely manner to help you get your money. But ultimately it comes down to your insurance company and their policies.
If this is just too expensive for you, I understand. Therapy is an investment of money, time, and emotional energy. You can always look up your insurance in-network providers to see if you can use your benefits in a more cost-effective way.
If this sounds like something that will work for you, get in touch with me!
Thanks for reading and have a wonderful day!
Kelly Burris is a Licensed Marriage and Family Therapist in California (LMFT #86688) specializing in treating trauma, sexual abuse, women’s issues, depression, and anxiety. Kelly works with clients to create a treatment plan specific to their goals and desires which can include using CBT, TF-CBT, EMDR, meditation, and collateral services. She can be reached at calicounseling@gmail.com or 949.391.8278