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The Transition House, Inc.

Will insurance cover my therapy?


You’ve been told counseling or some other type of therapy would greatly improve your mental health, but wonder will insurance cover mental health services.

Say your child may be suffering from depression and you wonder whether that treatment will be covered.

Many insurance plans do cover mental health services, but coverage depends on the provider and which state you have your coverage. Because of those variations, a good first step should be reviewing your health insurance policy or contacting your employer’s human resources department, according to Mental Health America.

Many of those covered by an insurance plan are not aware that their plan generally cannot treat coverage of mental health services different than what it pays for physical illnesses, according to the American Psychological Association.

A 2008 federal law – the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act – requires insurance providers to treat mental health and physical ailments equally. For example, if your insurance carrier requires a $20 copay for treatment of a physical condition, it can’t charge a $40 copay for mental health services.

The parity law applies to:

  • Employer-sponsored plans if the company has 50 or more workers
  • Coverage obtained through health care exchanges under the Affordable Care Act or Obamacare
  • Children’s Health Insurance Program (CHIP)
  • Medicaid

The parity law was also intended to address limits placed on the number of mental health treatment sessions. However, an insurance company can require an assessment to determine whether future treatments are medically necessary as long as it has a similar criteria for assessment for treatment of physical illnesses.

What the parity law does not address is whether your mental health provider is mandated to accept insurance benefits. Some therapists, counselors and other behavioral health professionals do not accept insurance because the payments they receive do not cover their costs, according to the American Psychological Association.

If you obtained health insurance through the Health Care Exchanges, mental health and substance abuse services is covered, according to HealthCare.Gov. However, your level of coverage will depend on the state in which you obtained coverage.

Most insurance plans also cover preventive services, such as depression screenings or behavioral assessments, according to MentalHealthCare.Gov.

In addition to creating a marketplace for Americans to obtain health care insurance coverage, the Affordable Care Act or Obamacare placed coverage requirements on insurance companies. For example, insurance companies can no longer deny coverage for mental health services because of a pre-existing condition.

Want to know more about how this federal law impacts veterans, Hispanics and the consumer protections it puts in place? The National Alliance on Mental Illness answers many questions concerning coverage, including veterans and Hispanics and what consumer protections the law puts into place.

Refer a patient to TTHI Counseling Center

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