Does Insurance Cover Therapy? A Guide for Parents 

Reviewed for Insurance Criteria by Perkin Chung, Senior Vice President of Payor Relations 

As a parent, navigating the world of therapy for your child can be overwhelming. One common question many parents have is whether insurance covers therapy services. Here’s what parents need to know about what insurance covers regarding therapy and mental health treatment, as well as important next steps parents can take to find treatment for their teen or young adult. 

Does Insurance Cover Therapy and Mental Health Treatment? 

Insurance can cover therapy and mental health treatment depending on the plan’s specifics and coverage. Understanding your plan’s benefits, such as copays and covered therapies, can help you understand the payment options available to help your teen and family mental health treatment costs.

Do Both Individual and Employer Insurance Plans Cover Therapy? 

Both individual and employer insurance plans may cover therapy, but the extent of coverage varies by plan. Employer plans often offer extensive mental health benefits, while individual plans may have specific therapy coverage. Here are some of the differences parents will need to know when seeking treatment for their teen or young adult: 

Employer Coverage for Therapy 

Employer coverage for therapy varies among insurance companies. Many health plans provide mental health services through employer insurance plans that cover teen family members and dependents who need mental health treatment.  

Employer-sponsored health insurance can offer more comprehensive and affordable coverage for therapy due to significant employer contributions towards premiums. Employer coverage can also include larger in-network provider networks and easier access to specialists. This can make employer plans a favorable option for families seeking therapy services for their teens or young adults.  

Individual Coverage for Therapy 

Most individual health insurance plans cover mental health services, including individual, group, and family therapy, as well as a variety of treatment options, such as outpatient or inpatient therapy. However, Individual health insurance plans, including supplemental insurance, may come with higher out-of-pocket costs. Coverage can vary widely, with higher copayments, coinsurance, and deductibles compared to employer plans. These plans often have narrower provider networks and may require referrals for specialist care. It’s important to note that individual plans may provide more customizable coverage plans, including coverage for mental healthcare and therapy, if a family knows they want specific coverage, therapy, or treatment options. 

What are Some of The Different Types of Insurance Coverage for Therapy? 

Some  types of coverage for therapy can include in-network coverage, out-of-network coverage, insurance reimbursement, and single-case agreements. Here’s what parents need to know about the differences and costs of each: 

In Network Coverage 

In-network coverage refers to using healthcare providers contracted with your insurance company. These providers have agreed to specific rates, often resulting in lower out-of-pocket costs for your family. 

Out of Network Coverage 

Out-of-network coverage refers to therapy services provided by professionals outside of your insurance plan’s network. While these services may offer flexibility and choice, they may come with higher out-of-pocket costs. Some resources that can help reduce the costs of out-of-network treatment for parents and families include financial assistance programs, employer insurance options, online therapy options, and sliding scale fees. 

Insurance Reimbursement 

Insurance reimbursement is when an insurance company pays back the cost of therapy sessions covered under the policy. It involves submitting a claim with proper therapy or treatment provider documentation. Reimbursement rates can vary depending on the insurance plan and provider agreements. 

What Types of Treatments and Therapies are Typically Covered by Insurance? 

Insurance often covers a variety of individual, group, and family therapy, outpatient and inpatient treatments, psychiatric services, and online therapy options. Understanding your insurance’s coverage for these therapies can help plan for mental health treatment costs. Common therapy types covered by insurance can include trauma-focused cognitive behavior therapy (CBT), dialectical behavior therapy (DBT), transcranial magnetic stimulation (TMS), eye movement desensitization and reprocessing (EMDR), and occupational therapy. 

Treatments Commonly Covered by Insurance 

• Outpatient Treatment Options: Outpatient treatment options provide flexibility for parents seeking therapy for their children without the need for full-time care. These options typically include individual, group, and family counseling sessions, and therapy appointments, which can be scheduled around school and other commitments. Outpatient treatment options that can be covered or reimbursed by insurance can include an intensive outpatient program (IOP) or a partial hospitalization program (PHP), both of which can help teens who could benefit from mental health treatment while living at home. 
• Inpatient Treatment Options: Inpatient treatment options offer comprehensive care within a specialized facility for intensive mental health support that can include individual, group, and family therapy and can often be covered or reimbursed by insurance plans. These programs, such as residential treatment centers, therapeutic boarding schools, and transitional living programs, provide 24/7 monitoring and structured therapy for adolescents, teens, and young adults who need a higher level of therapy and care. 
• Online Therapy Options: Online therapy options offer convenient access to mental health services through digital platforms and can often be covered or reimbursed by insurance plans. These options can include programs such as a virtual intensive outpatient program (VIOP) that can include various forms of therapy and counseling and can provide flexibility for teens and young adults who would benefit from treatment from the comfort of home.  

How Much of the Cost of Therapy Will Insurance Cover? 

Insurance plans will typically cover a percentage of the cost of therapy or treatment services, with the exact amount depending on the type of health insurance coverage you have. The percentage of coverage paid by families will depend on criteria such as copay, coinsurance, and health insurance deductible that may need to be paid before or during insurance for therapy or treatment. 

It’s also important to note that certain insurance companies and plans may reimburse some treatments and services, making the average cost of therapy more affordable for those with insurance coverage and reimbursement rates. 

What Charges Will I Be Responsible for From Therapy or Treatment? 

While insurance coverage may help reduce the cost of therapy, there may still be additional costs that you will need to pay. These additional costs can include deductibles, copays, co-insurance, and any out-of-pocket expenses. 

• Deductibles are an important factor to consider when planning for therapy or treatment expenses. They represent the initial amount you are responsible for paying before your insurance coverage kicks in to help you cover the costs. 
• Copays can help reduce the upfront cost of services like therapy sessions. Co-pays are fixed amounts that you may pay for each mental health visit or service after a deductible has been met. This amount is typically specified in your insurance plan and can vary depending on the specific plan and the type of therapy you receive. For example, an insurance company can’t charge a $40 copay for office visits to a mental health professional such as a psychologist. 
• Co-insurance is the percentage of the therapy cost that parents may be responsible for paying, and it can be paid alongside copays. 
• Out-of-pocket costs may be those for services not covered by your insurance plan. These could include the deductible and could also include certain types of therapy or specific treatment modalities that are not deemed medically necessary by your insurance plan. 

Which Insurance Providers Typically Offer Coverage for Therapy? 

Many insurance providers and health insurance companies offer coverage for therapy as part of their mental health services. The availability and extent of coverage can vary between providers and insurance plans. When choosing an insurance provider that offers mental health coverage for therapy, it’s important to consider factors such as the specific therapy services you require, including substance use disorder services, and the level of coverage you need. 

Some of the providers that can offer coverage options at Embark Behavioral Health include but are not limited to: 

• Aetna 
• Allegiance 
• Anthem and Blue Cross Blue Shield affiliates 
• Carelon 
• Cigna 
• Kaiser 
• Providence 
• United Healthcare / Optum 
• Valley Health Plan 

We Work with Most Insurance Providers.  

If your insurance carrier isn’t listed, contact us, and we’ll help you find an insurance option that works for your family.  

How Can I Find Out if My Insurance Covers Therapy for My Teen? 

If you are a parent and want to find out if your insurance covers therapy for your teen, take a look online for the details of your coverage and plan, talk to your insurance or HR department for more information, or contact the therapist or treatment provider by calling or filling out an insurance verification on their website.

1. Look Online for Details on Your Insurance’s Therapy Coverage 
   One way to find out if your insurance covers therapy for your teen is to look online for details on your insurance’s therapy coverage. Many insurance providers have websites that provide information on mental health services and coverage options. Look for specific details on therapy coverage, including any limitations, copays, or requirements for accessing therapy services. 
2. Talk to Your HR Department or Insurance Provider 
   To clarify insurance coverage for your teen’s therapy, engaging with your HR department or insurance provider can help determine what family coverages are available for teens or dependents. They can provide detailed insights into the coverage specifics, including any limitations or additional benefits available. You may also be able to take a look at employee resources and documents that outline more of the specific plan details that may cover therapy for your teen or young adult. 
3. Contact the Treatment Provider to See What Insurance They Accept 
   Contacting the treatment provider to inquire about accepted insurance can provide a direct route to determining if they accept your insurance and any additional information that can be helpful when looking at beginning treatment. By directly reaching out to the treatment facility, you can clarify which insurance plans they accept, ensuring smooth payment processes and avoiding unexpected costs. 

What If I Need More Help with the Costs of Therapy? 

There may be instances where insurance doesn’t cover the full cost of your teen’s treatment. For parents who are looking for other payment options to help with the costs of therapy and insurance, financial aid and sliding scale fees, payment plans, non-profit organizations, sliding scale fees, and employee assistance programs can offer parents and families some additional ways to save on treatment and therapy. 

• Sliding Scale Fees are a common solution many therapy providers offer to make mental health services more affordable. These fees are typically based on income and ability to pay and can help lower the costs for parents who are looking for additional financial assistance for therapy and treatment. 
• Non-profit organizations also play a vital role in bridging the gap for families and young people who may not have adequate insurance coverage to pay for the full cost of treatment. These organizations can also provide helplines for young people who may benefit from talking to someone. Some organizations that may be able to help provide families with payment assistance or treatment options that accept their insurance include The Trevor Project and the National Alliance on Mental Illness. You can also use online search tools, such as those provided by the American Psychological Association and Psychology Today, to find therapists who accept your insurance and may offer lower-cost therapy or treatment that works with your insurance. 
• Employee assistance programs (EAPs) are another resource that can help offset the therapy costs for both employees and their families. EAPs offer Employee assistance programs (EAPs), a valuable resource many employers provide to support their employees’ mental health needs. These programs offer confidential assessments, short-term counseling, referrals, and follow-up services to employees and their family members.They are usually at no cost to employees and families. 
• Medicare and Medicaid may help cover the costs of therapy and treatment services such as outpatient therapy services, individual and group therapy sessions, psychiatric evaluations and medication management, and preventive services like depression screenings.  
• Children’s Health Insurance Program (CHIP) provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid but cannot afford private insurance. CHIP can help cover the costs of therapy and mental health services for children and families who may be unable to pay for insurance or out-of-pocket costs.  

It’s important to note that Embark Behavioral does not accept CHIP, Medicare, or Medicaid payment options for our programs, but we do provide many flexible in-network and out-of-network payment options for parents and families who are looking for help with treatment. 

Looking for Insurance Options for Treatment and Therapy? 

If you’re looking for treatment and therapy options for adolescents, teens, or young adults in the United States, we’re here to help. We work with most insurance companies and can help you find healing treatment options and verify your insurance through a few quick steps. Contact us or call us and we’ll help you find an insurance option for your family.

Insurance Coverage for Therapy: Next Steps 

Understanding your insurance coverage for therapy is important in accessing the mental health care your teen needs. We understand that the process of finding a treatment program or therapy option for an adolescent, teen, or young adult who would benefit from mental health treatment can seem overwhelming. We’re here to help you find a treatment and insurance option that can help your family start healing. Contact or call us at 866-479-3050 and we’ll walk you through each step of verifying insurance and starting treatment. 

Frequently Asked Questions 

Can insurance cover the full cost of therapy? 

Insurance typically covers a portion of therapy or treatment costs but not always the full amount. Factors like deductibles, copays, and coverage limits can affect how much is covered. Understanding your insurance plan’s specifics is crucial to determine the extent of coverage. 

Are all types of mental health professionals covered? 

Insurance coverage for therapy may vary depending on the specific health plan and insurance provider. While many types of mental health professionals are covered, it’s important to check with your insurance provider to ensure that the specific therapist or treatment provider you choose is included in your network and that your plan covers their services. 

What are the common limitations of therapy coverage? 

Common limitations of therapy coverage may include restrictions on the number of therapy sessions covered per year, the requirement for a referral from a primary care physician, and limitations on coverage for certain types of therapy or treatment modalities. It’s important to review the specifics of your insurance plan to understand any limitations or restrictions that apply. 

Tips for maximizing your therapy coverage benefits 

To maximize your therapy coverage benefits, consider the following tips: 

• Understand your insurance plan and the coverage it provides for therapy services. 
• Choose an in-network therapist or treatment provider to minimize out-of-pocket expenses. 
• Keep track of your therapy sessions and any related expenses for insurance reimbursement purposes. 
• Utilize any additional resources your insurance plan provides, such as telehealth services or other mental health support programs. 

*None of the content in this article should be considered legal or financial advice.