Does my insurance cover mental health care?
Contents
Does my insurance cover therapy or coaching?
How do I find a therapist that accepts my insurance?
What Are My Affordable Mental Healthcare Options?
What Are Out-of-Network Benefits vs. In-Network Benefits?
Demystifying Health Insurance Language
What Is an Eligibility Check?
What Is a Co-Pay vs. Coinsurance vs. Deductible?
What is HMO vs. PPO
What Is a Superbill?
Understanding your insurance benefits can feel like a nightmare. How do you make sense of all the acronyms and healthcare terms? We get that it makes the process of finding affordable mental healthcare options feel overwhelming, and we’re here to clarify that process.
As the importance of mental wellbeing becomes more widely acknowledged in the United States, mental health is starting to receive more care and attention. Historically, it hasn’t always been granted the same coverage as physical health by insurers, as health insurance companies offered more comprehensive coverage for physical ailments than for mental health conditions due to considerations around “medical necessity”.
That’s why the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act was passed in 2018. Also known as the Mental Health Parity Law or Federal Parity Law, the Act requires that coverage for mental health, behavioral health, and substance-use disorders be equivalent to the coverage offered for physical health. But what does that actually mean for you? What services are available to you and how do you make the most of them?
We created this straightforward guide to help you through the process. Access to mental healthcare is already challenging for BIPOC communities due to disproportionate barriers and financial hurdles, compounded by limited resource sharing within our communities, low mental health awareness, and the stigma surrounding the topic.
Since our mission at Anise is to make mental health care accessible to all, we’re breaking it down for you to simplify mental health insurance coverage and make the process less intimidating, so you know how to access and utilize the mental health services available to you.
Does my insurance cover therapy or coaching?
First, you’ll need to determine if your health insurance covers therapy and coaching. Currently, most plans will include individual therapy, group therapy, and family therapy for sessions up to 60 minutes with a licensed therapist. Coaching, however, is not classified as a medical treatment and, as a result, coverage for coaching can vary significantly across health plans.
How can you find out the details of your coverage? Take a look at the official documents of your policy or consult your insurance provider to understand which specific services are covered in your plan.
If this sounds overwhelming, Anise Health can help you run an eligibility check. Furthermore, our program covers both therapy and coaching, so you won’t need to worry if you’ll need to pay separate co-pays. It’s all included with Anise!
How do I find a therapist that accepts my insurance?
So you’ve determined that your policy includes therapy, and now it’s time to find the right therapist. In addition to finding someone who’s the right fit for you personality-wise, you want to be sure they accept your insurance in order to reduce out-of-pocket costs. Here are a few places to start looking:
1. Insurance provider directory
Your insurance provider will provide a list of in-network therapists. You can usually find a member services phone number on the back of your insurance card or on their website. Some customer support lines have long wait times, so it’s important to have your policy information ready when you are able to speak with an agent. This includes the policyholder’s full name, member ID or policy number, group number, and plan type.
2. Referrals
Your primary care physician (PCP) or other healthcare professionals will likely be connected with a network of behavioral health specialists that they have built relationships with. You can ask your PCP or medical professional to refer you based on your needs. Some professionals will know the therapists who accept your insurance, so you can always ask for a referral.
3. Online directories
If neither of these options are working out for you, publicly available online directories that specialize in mental health could help. For example, Psychology Today offers an online resource that allows you to filter therapists by insurance provider, as well as detailing information like their speciality, approach to therapy, and contact information.
4. Direct contact
If you come across a therapist or service that interests you, but you’re still not sure if they accept your insurance, simply ask! Give them a call or send an email to verify if it’s a match and if they have availability. It’s a good idea to do this anyway to be sure you receive the most up-to-date information.
What Are My Affordable Mental Healthcare Options?
Even with insurance, therapy can still seem like a daunting financial burden. But not to worry! There are several ways to access affordable healthcare that is culturally-responsive and tailored to your needs regardless of how robust your insurance benefits are.
HSA/FSA
Many commercial insurance options offered by employers include access to a Health Savings Accounts (HSAs) or Flexible Spending Accounts (FSAs), which allow you to set aside money before taxes to pay for healthcare expenses. If you withdraw money from this account, that money is also tax-free if they cover qualified medical expenses. Anise Health is one of those qualified services, and our self-pay subscriptions can be paid for using an HSA/FSA debit card!
The difference between the two is that HSAs allow you to carry unused funds into the future, so your money is still there in the following year. However, FSAs operate under the principle of “use it or lose it,” meaning that you’ll forfeit the remaining unused funds in the account at the end of the year. Also, you can invest money in your HSA to benefit from compound interest; this isn’t possible with an FSA. Finally, to be eligible for an HSA, you have to be enrolled in an HSA-eligible health plan which is determined by your healthcare insurance. FSAs, on the other hand, are employee benefits that anyone can contribute to if your employer offers it.
Nonprofit Organizations
In addition to local initiatives, many non profit organizations are committed to providing affordable therapy services to underserved populations. For example, the Asian Mental Health Project’s mission is to educate and empower Asian communities by hosting events, festivals, training, and programs. One activity they provide is raising funds for a financial assistance program called the RestorAsian Scholarship, which awards one free month of therapy and coaching. Similarly, another nonprofit is Letters 2 Strangers, a global youth mental health organization that also has a scholarship program for patients and providers.
Peer Support Circles
Peer support circles are a chance to come together and discuss your mental health with others who share similar experiences. These recurring groups provide another forum for connection and a sense of belonging, while helping to reduce feelings of burnout, stress, or anxiety.
A support group can be clinician-led or group-facilitated, and can act as a space to process your lived experiences and to share how your culture and heritage inform your mental health, knowing that those who are listening “get it” and have been through it, too. Read more about the benefits here.
Psychoeducational trainings or workshops
If you want to learn more about a specific mental healthcare topic but are not ready for individual care or support groups, you can also join a psychoeducational workshop hosted by various organizations. Companies often partner with external third-parties like Anise to bring in subject-matter experts for training sessions or workshops on themes including:
Sleep Hygiene
Strengthening the Mind Body Connection
Overcoming Imposter Syndrome
Intersectional Identities and Values Exploration
Burnout Prevention and Recovery
Navigating Perfectionism
Executive Presence and Leadership Coaching
Organizations can also cover more clinical topics, such as:
Maternal Health and Postpartum Depression
Intimate Partner Violence
Health Equity Post COVID-19
These programs can help increase your own knowledge and awareness about the ways in which identity and culture influence our mental health and lived experiences. For example, in Anise Health’s workshop on Destigmatizing Mental Health, we review practical tips to unpack your own sources of stigma and share insights on how to find the right therapist or coach for people of Asian descent.
What Are Out-of-Network Benefits vs. In-Network Benefits?
Within the group of therapists who accept your insurance, you will still find two distinctions: in-network and out-of-network. Understanding the difference between them will help you effectively manage your healthcare costs.
In-Network: Providers within your insurance network will have negotiated rates with the insurance company, to help you get the lowest cost possible.
Out-of-Network: Providers who are out of the network may still accept your insurance, however you could have higher out-of-pocket costs, and may need to pay upfront and request reimbursement from your provider later.
In order to understand the specific differences, check your policy to learn the percentage of costs covered for in-network vs out-of-network services.
Anise Health can issue superbills for out-of-network benefits. This is essentially an invoice which includes an itemized list of all the services provided to a client, and contains information about the practice, the Current Procedural Terminology (CPT) code, the referring provider and more. These are also known as “charge slips”, “encounter forms” or “fee tickets.” This can help reduce the cost of care even if your provider is out of network. Want more details about superbills? Read on!
Demystifying Health Insurance Language
Healthcare insurance can be complex. Here are some common terms and processes explained, so you aren’t bogged down by the details and can get the care you need.
1. What Is an Eligibility Check?
An eligibility check confirms whether your insurance plan covers the specific services you need. This process includes:
Verification: Checking with your insurance company to confirm coverage details and any limitations or exclusions.
Pre-Authorization: Some services require approval from your insurance company before they are provided. This ensures the service is covered and helps prevent unexpected expenses.
Limitations: Identifying any restrictions in coverage, such as the number of sessions covered or specific types of therapy that may not be included.
We at Anise Health will do this eligibility check for you - free of charge - to save you time and ensure there are no surprise fees down the road!
2. What Is a Co-Pay vs. Coinsurance vs. Deductible?
A co-pay is a fixed fee that your insurance company requires you to contribute out of pocket towards a covered service, for example $20 for each therapy session. It’s typically due at the time of service or charged immediately after to the card on file.
A deductible is the amount you have to pay out-of-pocket before your insurance begins to cover expenses. For example, if your deductible is $1,000, you need to cover this amount before your insurance starts paying.
Coinsurance is the term to describe your share of the costs of a covered service, calculated as a percentage. For instance, if your coinsurance rate is 20%, you pay 20% of the service cost, and your insurance covers the remaining 80%.
Your out of pocket maximum is the most you will have to pay for covered services in a policy period (usually a year). Once you reach this maximum, your insurance covers 100% of the costs.
3. What is HMO vs. PPO
Health Maintenance Organizations (HMOs) and Preferred Provider Organizations (PPOs) are common types of health plans. Here’s the difference between them.
HMO requires you to use a network of doctors and hospitals. You need a referral from your primary care doctor to see a specialist, and it generally has lower premiums and out-of-pocket costs but less flexibility in choosing providers.
PPO offers more flexibility in choosing healthcare providers and seeing specialists without a referral. It generally comes with higher premiums and out-of-pocket costs but offers the advantage of allowing you to use both in-network and out-of-network providers, though at different coverage levels.
4. What Is a Superbill?
A superbill is a detailed invoice that your therapist can provide you, outlining the services they have provided to you, so that you can submit it to your insurance provider for reimbursement. It's generally used when your therapist is out-of-network or doesn't bill the insurance company directly.
Here’s a breakdown of what a superbill is and how to use it.
What information does a superbill include?
Patient Information: Name, address, date of birth, and insurance details.
Provider Information: Name, address, phone number, National Provider Identifier (NPI), and tax identification number.
Service Details: Dates of service, descriptions of services or treatments provided, procedure codes (CPT codes), and diagnosis codes (ICD-10 codes).
Charges: Itemized costs for each service rendered.
Payment Information: Any payments made by the patient.
How to Use a Superbill
After your appointment, your healthcare provider will give you a superbill if they don't directly bill your insurance.
Ensure all the information is accurate, including your personal details, the services listed, and the codes used. Verify the dates and charges for accuracy.
Obtain a health insurance claim form from your insurance company's website or by contacting their customer service. Fill out this form with the required personal and insurance information.
Attach the superbill to the completed claim form. Some insurance companies allow online submissions through their member portal, while others require you to mail the documents to a specified address.
After submission, follow up with your insurance company to ensure they received your claim and to inquire about the processing timeline. Be prepared to provide additional information if requested.
Once the insurance company processes your claim, they will send you an Explanation of Benefits (EOB) detailing what was covered and the reimbursement amount. You will receive the reimbursement directly if you paid the provider upfront.
Final Thoughts
Navigating mental health care and insurance can be complex, but understanding your coverage and options makes it more accessible. At Anise, we work with various insurance plans (and are adding more sono) to make mental health care more accessible, including
Aetna (California only)
Magellan Health (California only)
Managed Health Network / HealthNet (California only)
Anthem Blue Cross of California
Anthem Blue Cross and Blue Shield (New York only)
Premera Blue Cross (Washington only)
Regence BlueShield (Washington only)
Optum Behavioral Health / UnitedHealthcare (Washington + Florida only)
If you don’t have any of these, you can sign up for our email list to be the first to know when we begin accepting coverage from additional insurance plans or get started with one of our affordable self-pay options.
Understanding and utilizing your health insurance can help you access the mental health care you need. We at Anise Health are dedicated to providing you affordable, effective and culturally-responsive mental healthcare.
