Does Insurance Cover Outpatient Mental Health Services & Therapy?

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Does Insurance Cover Outpatient Mental Health Services & Therapy?

Yes, insurance may cover the cost of outpatient mental health services and therapy. However, this may depend on your specific insurance provider, plan, location, and other factors.

Outpatient mental health services cover a variety of treatments. It alludes to therapeutic services provided at a clinic, hospital, or doctor’s office but does not call for an overnight stay. Instead, those who receive therapy in an outpatient setting as opposed to a residential or inpatient setting go home every night after attending treatment for a set amount of time during the day or evening.

There are numerous types of outpatient mental health treatment programs available, including the following:

• Individual therapy: a person works one-on-one with a therapist to address unresolved emotions, traumatic experiences, and mental health issues utilizing various tactics and approaches.¹
• Group therapy: Licensed therapists usually oversee group therapy, including a range of individuals. Typical group therapy sessions concentrate on specific issues that everyone in the group is addressing. A therapist might facilitate a session(s) on anger control, postpartum depression, or grief, for instance.
• Family therapy: Family members meet with a therapist in a form of psychotherapy called family therapy to work through problems. A marital and family therapist (MFT) with training in family therapy frequently provides this type of treatment.
• Support groups: People who have or are now going through comparable experiences are brought together in support groups. They may discuss their personal stories, thoughts, coping mechanisms, or firsthand knowledge of illnesses or treatments.²
• Intensive Outpatient Care (IOP): Most illnesses, such as depression, eating disorders, addiction, and anxiety, can be treated with IOP programs as long as they don’t require detox or round-the-clock care.
• Partial Hospitalization Programs (PHP): PHP are organized daytime activities that combine inpatient and outpatient care needs. Patients often engage in recovery-related activities for eight hours a day, five days a week.
• Psychiatric medications and outpatient medication management: Medication management entails an initial assessment of the patient’s need for psychiatric medications, prescriptions, and ongoing medical supervision of the patient’s psychotropic medication use by a licensed doctor or prescriber.

State & Federal Insurance Program Outpatient Coverage

The Mental Health Parity and Addiction Equity Act mandates that any health plan providing physical health insurance coverage must include mental health care and substance use disorder services. Additionally, that coverage must be equal. This means, for instance, an insurance provider cannot impose a $40 payment for appointments with a psychologist if it only imposes a $20 copay for most medical/surgical appointments.³

In addition, the Affordable Care Act outlines ten categories of services known as essential health benefits. These categories include pregnancy and delivery services, inpatient and outpatient hospital care, prescription drugs, medical services, and more.⁴ Some plans offer additional benefits beyond the essential. The federally facilitated health insurance marketplace, large employer plans, some small employer group plans, and individual plans are just a few of the areas that the above affects.⁵

With that in mind, Medicare insurance for outpatient therapy requires you to pay a deductible and your portion of the costs associated with an inpatient or outpatient visit when you have original Medicare (Part A and Part B). Part A of Medicare covers the individual’s lab test results, hospice treatment, and time spent in hospitals and skilled nursing institutions. Doctor visits and home health care services are covered by Part B. Additionally, it might pay for some preventive care, such as cancer and depression screenings.⁶

Tennessee’s Medicaid program, TennCare, also includes outpatient mental health services insurance coverage.⁷

How to Verify Outpatient Therapy Insurance Coverage

Athena Care is in-network with most major insurance plans. The best way to learn more about your outpatient mental health services insurance coverage is to call your insurance provider or contact us below, for care in Tennessee.

A care coordinator will thoroughly review your plan and assist you with any questions or concerns regarding insurance for behavioral health services Monday through Friday, 7:00 a.m. to 6:00 p.m., at one of our multiple mental health clinics in Tennessee.

Requirements, Eligibility & Process for Outpatient Behavioral Health Services

In most instances, health professionals, like a primary care physician or related, will provide you with a referral. An intake assessment will follow this referral form, typically the first step in most outpatient mental health programs. Once the assessment is complete, a treatment plan, which may or may not include medications, will be discussed and implemented.

Outpatient behavioral health services insurance coverage may cover all, some, or none of your testing and treatment. These decisions are based on things like your particular health plan, whether you’ve received a formal diagnosis by a licensed professional, whether the provider is in-network or out-of-network, and the nature and requirements of the outpatient program. For example, some health insurance plans only cover a set amount of treatment sessions, but the outpatient program involves additional sessions.

In addition, some insurance plans will not cover alternative therapies, like music and art therapy or acupuncture. Most insurance companies deem these treatments ” exploratory, ” and you’ll likely be responsible for the total cost.

How you are reimbursed for your outpatient treatment depends, again, on whether or not your particular treatment is in-network or out-of-network. If it is in-network, the insurance company handles most logistics once you’ve met your deductible and paid any required copays. If your treatment is out-of-network, you will likely have to be more hands-on. For example, you’ll usually have to submit your own claims to the insurance company following treatment.

How Much Does Outpatient Treatment Cost Without Insurance

Suppose you don’t have outpatient therapy insurance coverage. In that case, the cost of outpatient treatment can vary depending on several factors, including geographic location. The following are average costs, though they may vary and may not reflect the final cost of treatment or what you may 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 demand more.⁸ According to Drughelpline.org, three months of outpatient rehab treatment costs between $1,400 and $10,000.⁹

Finding ways to pay for outpatient therapy 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.