Is IOP Treatment Covered by Insurance?

Jump to Section

Is IOP Treatment Covered by Insurance?

Yes, insurance may cover intensive outpatient programs (IOPs). Insurance coverage for mental health services depends on your specific insurance provider, plan, location, and other factors. The expense of outpatient therapy is usually partially, if not entirely, covered by insurance; however, the number of days or sessions may be restricted by your policy.

An intensive outpatient program is a direct intervention, and the objective is noticeable progress in the shortest amount of time.¹ IOP programs are a thorough method of treatment that provides a higher standard of care than typical therapy. These therapy services are normally delivered in mental health treatment centers, doctor’s offices, or hospitals.

IOPs are suitable if you don’t require detox or 24/7 care. They typically consist of two categories: mental health and addiction treatment programs for substance abuse. Additionally, there are subcategories.

Intensive outpatient programs typically occur several days per week for several hours each day. Participants must attend group or individual therapy or treatment as well as recreational activities per a set schedule. IOP is occasionally used when a patient has completed inpatient treatment but needs assistance transitioning back into their routine.

Unlike long-term therapy, which poses certain difficulties, like requiring you to miss a significant amount of time from family and employment, IOP programs allow you to return home after receiving intensive daily treatment.² Still, you may want to consider work leave if a psychiatrist deems it medically necessary.³

IOP treatment has several advantages, including:

• Connections to a strong support network
• Ability to maintain and manage daily responsibilities
• Acquiring new coping techniques, like self-care and effective communication
• Assistance in the transition from inpatient to outpatient care
• More affordable than inpatient residential treatment
• Scheduling flexibility
• The option for virtual treatment

Anyone having trouble with daily life will benefit from outpatient mental healthcare. IOP programs allow you to be around people going through similar experiences. When you form close bonds with people who share your experiences, you can feel a sense of community and hope. IOP mainly works for those with a solid support system and high-functioning independence.

How to Verify IOP Insurance Coverage

Athena Care’s multiple mental health clinics in Tennessee are in-network with most major health insurance plans. Therefore, the easiest and most efficient way to learn about your IOP insurance coverage is to complete our free, confidential, no-obligation online insurance verification form.

One of our expert care coordinators will handle the hassles of contacting your insurance provider to verify coverage. They’ll thoroughly review your plan and assist you with any questions or concerns regarding your IOP insurance benefits, Monday through Friday, 7:00 a.m. to 6:00 p.m.

Insurance may be able to help cover the cost of therapy. Find out if your insurance can help with the costs by calling your insurance provider or by contacting us below. One of our care coordinators can help you navigate your insurance coverage and get the care you need.

Requirements, Eligibility & Process for IOP Coverage

You’ll most likely need a formal diagnosis from a licensed healthcare professional to access intensive outpatient therapy insurance coverage. IOP insurance coverage usually includes assessment, treatment, and medication (if needed).

In addition, the treatment facility may be required to obtain prior authorization. An initial number of authorized visits will be approved if the insurance provider finds it medically necessary. The weekly hours for each specific IOP program may differ; however, each insurance provider mandates minimums.

The facility may occasionally need to send a concurrent review to the insurance company to request more sessions or notify them that a member has been released from the program. Also, if a member misses any sessions, some insurances demand an update since IOP is considered an “all or nothing” treatment.

Whether your treatment is in-network or out-of-network will also affect intensive outpatient program insurance coverage. Once you’ve reached your deductible and paid any necessary copays, the insurance provider, if it’s in-network, will take care of most of the logistics. However, you’ll probably need to exert more effort if your treatment is out-of-network. For instance, you’ll typically need to file your own claims to the insurance provider after receiving treatment.

Furthermore, any “exploratory” or alternative therapies, like acupuncture or music therapy, administered as part of an IOP program may not be covered by insurance. This is because insurance companies typically don’t deem these types of treatments as medically necessary.

How Much Does IOP Cost Without Insurance

Suppose you don’t have IOP insurance coverage. In that case, the cost of outpatient treatment can vary depending on several factors, including location. The expenses listed below are averages, but they could differ. They may not accurately represent the total cost of care or what you might pay in Tennessee.

The cost of a single therapy session in the United States typically ranges between $100 and $200. Still, many providers may charge less, while others will expect more.⁴ The price for IOP typically varies depending on the facility, but one day of treatment might be anywhere from $250 to $350.⁵ However, the cost of the program you enroll in can be outside of this range, and the most influential factor in this is the types of outpatient services offered.⁶

Finding ways to pay for IOP is still feasible despite the cost. Some licensed mental health professionals offer a sliding scale price, which bases your payment on your income. Additionally, you might be able to negotiate with a facility or doctor about reductions, financing, or payment plans.