Insurance · finding a therapist
How to find a therapist covered by your insurance
Search your plan's own provider directory, then confirm by phone with the number on your insurance card and again with the practice. Ask whether the clinician is in network for your specific plan, not just the insurer. If you pay yourself, ask for a good faith estimate. This page explains each step; it does not tell you what your plan will pay.
Guide reviewed against HealthCare.gov, Medicare.gov, Medicaid.gov and CMS pages. Reviewed by Matthew Sexton, LCSW.
Five steps
- Search your plan's directory. Log in to your insurer's member portal and filter for mental or behavioral health providers near you or by telehealth.
- Call the number on your card. Ask member services whether the clinician is in network for your plan, whether you need a referral or prior approval, and what you will owe per session.
- Confirm with the practice. Directories can be out of date. Ask the practice directly whether they take your plan and are accepting new clients.
- Check the license. Insurance status is not a license check. Look the person up in the state register (guides below).
- Write it down. Note who you spoke to, the date, and what they said.
In-network and out-of-network
A plan's network is the providers it has contracted with. An out-of-network provider has no contract with your plan. Your plan may pay less for their care or nothing, and the provider may bill you the difference between their charge and your plan's allowed amount (called balance billing). How your plan handles each is in your plan documents; member services can explain it.
HealthCare.gov says all Marketplace plans cover mental health and substance use services as essential health benefits, including psychotherapy and counseling, and must follow parity rules so those limits are not more restrictive than medical ones. Other plan types can differ; ask yours.
Superbills and out-of-network reimbursement
Some clients pay an out-of-network therapist directly, then submit an itemized receipt (often called a superbill) to their plan and ask for reimbursement. Some plans reimburse part of the cost; some pay nothing. Before you rely on it, ask your plan whether you have out-of-network benefits, any deductible that applies first, and how to submit a claim.
Medicare and Medicaid
Medicare. Part B covers outpatient mental health services from psychiatrists and other doctors, clinical psychologists, clinical social workers, clinical nurse specialists, nurse practitioners, physician assistants, marriage and family therapists, and mental health counselors. Your costs depend in part on whether the provider accepts assignment, so ask.
Medicaid. Each state runs its own program within federal rules: some benefits are mandatory and states may add optional ones. Check your state Medicaid program or plan's directory and member line the same way.
Paying yourself: the good faith estimate
Under the No Surprises Act rules CMS describes, if you are not using insurance to pay, a provider usually must give you a good faith estimate of expected charges. Schedule 3 to 9 business days ahead and you get it within 1 business day; 10 or more business days ahead, within 3 business days. If the bill comes in at least $400 above the estimate, you can dispute it; the initial bill must be dated within the last 120 calendar days. You cannot dispute without the estimate, so keep it.
Questions to ask the practice
- Are you in network for my exact plan, and on what date did you last confirm that?
- If not, do you provide a superbill?
- What is your fee if I pay myself, and will you give me a good faith estimate?
- Are you accepting new clients, and do you offer video, in person, or both?
- What license do you hold, and in which state?
Check the license too
Being in a plan's network does not replace checking the state register yourself.
Sources
- HealthCare.gov: network
- HealthCare.gov: balance billing
- HealthCare.gov: mental health coverage
- Medicare.gov: outpatient mental health care
- Medicaid.gov: mandatory and optional benefits
- CMS: good faith estimate
- CMS: dispute a bill
General information, not legal, billing, or coverage advice. Your plan's documents govern your coverage.
Questions about insurance and therapy
How do I find a therapist that takes my insurance?
Start with your plan's own provider directory, usually in the member portal, and filter for mental or behavioral health. Then call the member services number on your insurance card to confirm the clinician is in network for your specific plan, and confirm again with the practice before the first session.
What is the difference between in-network and out-of-network?
A plan's network is the providers it has contracted with. An out-of-network provider has no contract with your plan, so your plan may pay less or nothing, and the provider may bill you the difference between their charge and the plan's allowed amount. Your plan documents and member services say how your plan treats each.
What is a superbill?
An itemized receipt some practices give clients who pay them directly, which the client can submit to their plan to ask for out-of-network reimbursement. Whether your plan pays anything, and how much, depends on your plan. Ask your plan before you rely on it.
Does Medicare cover therapy?
Medicare Part B covers outpatient mental health services from several provider types, including clinical psychologists, clinical social workers, marriage and family therapists, and mental health counselors, according to Medicare.gov. Your costs depend on the provider and whether they accept assignment.
What if I pay for therapy myself?
If you are not using insurance to pay, a provider usually must give you a good faith estimate of expected charges when you schedule far enough ahead. CMS explains the timing and says you need the estimate to dispute a bill that comes in at least $400 higher.