Will my insurance cover my therapy costs?

Jul 11

Navigating the world of mental health care can feel overwhelming—especially when it comes to understanding your insurance. One of the most common questions we hear at Flourish Wellness Collective is:

“Will my insurance cover therapy?”

The answer isn’t always simple, but we’re here to help you make sense of it. Understanding your insurance coverage is key to accessing the support you need—without the stress of surprise costs. Let’s break down what you need to know, step by step.

Step 1: Understand Your Insurance Plan

Not all insurance plans are created equal. To start, ask yourself these questions:

What Type of Insurance Do You Have?

Private Insurance – Provided through an employer or purchased individually.
Government Programs – Includes Medicaid, Medicare, or other state-supported programs.

What Mental Health Benefits Are Included?

Coverage varies widely. Some plans cover a wide range of services; others have limits. Important things to check:

Do you need a referral from a primary care physician?
Are there limits on the number of sessions?

In-Network vs. Out-of-Network: What’s the Difference?

In-Network Providers: These therapists have agreements with your insurance company. You’ll usually pay less.
Out-of-Network Providers: You can still see them, but you may have higher out-of-pocket costs or need to submit claims for partial reimbursement.

Demystifying Insurance Jargon

Let’s be honest—insurance terminology can sound like another language. Here's a quick guide to some key terms:

Deductible: The amount you pay out of pocket before insurance starts to contribute. There may be separate deductibles for in-network and out-of-network care.
Copay: A flat fee (typically $20–$50) you pay at each session.
Coinsurance: A percentage of the session fee you’re responsible for. (e.g., if your coinsurance is 30%, you pay 30% of the cost.)
Out-of-Pocket Maximum: The maximum you’ll pay in a year. Once you hit it, insurance covers 100% of your care.

Steps to Check Your Coverage

Review Your Benefits

Start by looking at your Summary of Benefits and Coverage (SBC). This outlines what services are covered, including therapy.

Call Your Insurance Company

Use the number on the back of your card and ask:

Is therapy covered?
What types of therapy (individual, couples, etc.) are included?
How many sessions per year?
What’s my copay or coinsurance?
Do I need a referral or pre-authorization?

Verify with Your Therapist

Before booking, confirm that the therapist accepts your insurance. Many of our therapists at Flourish Wellness Collective have billers who are happy to help verify your coverage.

Understanding Potential Out-of-Pocket Costs

Even with insurance, you may still have costs such as:

Copays
Coinsurance
Meeting your deductible

Knowing this ahead of time can help you plan and avoid unexpected bills.

What If My Insurance Doesn’t Cover Therapy?

Don’t panic—there are still ways to get the care you need:

Sliding Scale Options: Many therapists (including ours!) offer lower rates based on your income.
Low-Cost Services: At Flourish, our student interns offer affordable therapy to ensure everyone can access support.
Community Clinics & Non-Profits: Local organizations may provide free or reduced-cost services.
Employee Assistance Programs (EAPs): Some employers offer short-term therapy through EAPs at no cost to you.
Private Pay: If you prefer a therapist who doesn’t accept your insurance, paying out of pocket might still be worth the investment in your well-being.