Updated: Sep 12, 2022
Counseling is an investment in yourself and your growth. Some people decide to engage in therapy to work on a specific area causing pain or trouble, like a phobia, relationship conflict, or grief. Some people flow in and out of therapy to revisit and strengthen learning around ongoing issues like anxiety or depression. And some work with a therapist in the long term to revisit and heal past trauma. Whatever brings you to counseling, you will be making an investment of both time and money.
On January 1, 2022, the No Surprises Act went into effect to protect consumers from unanticipated medical bills. If you do not have insurance to cover therapy, or if you choose to pay out of pocket, your therapist will give you a Good Faith Estimate (GFE) of what your therapy should cost. GFEs can help you decide how you want to move forward with therapy.
Many therapists choose not to accept insurance for a variety of reasons. One, the paperwork is
mountainous. Two, insurance companies reimburse therapists at a much lower rate than the average fee for an area. And three, insurance companies request diagnoses, treatment plans, and progress notes, all of which they must approve or they can deny reimbursement. Therapist therefore often choose to remain out of network (OON).
If your therapist is OON, you can still get some of your session fees reimbursed. Check with your insurance company about their process. It generally involves filling out a form and attaching an invoice, or super bill, that shows you paid for the service. Insurance companies generally have a fixed amount that they think the service is worth and reimburse about 40-60% of that amount. So let’s say your insurance company sets the amount for a 50 minute session at $90, and reimburses 50% for OON providers.
Your therapist charges $200 per session. You pay them that fee at the time of your session, and your insurance will reimburse you $45. (These amounts are for example only. Check with your insurance company for the specifics of your coverage.)
If your therapist provides a super bill, it must contain certain personal information including your identifying information, your diagnosis, and each time you attended therapy. It will also contain your therapist’s identifying information, their tax ID number, and their license. If you are uncomfortable with any of that, you can choose not to submit a claim for reimbursement. Be sure to ask your therapist for a GFE so you know what to expect!
I’m happy to say there is a lot more support for mental health today than ever before. Insurance companies are required to provide some coverage for it. Telehealth has opened up many new, cost effective ways to get support. Physicians now include a basic mental health questionnaire in every appointment to determine if you are struggling and refer you to mental health resources. If you are ready to invest in your mental health, find the way that works best for you and reach out!
For more information on the No Surprises Act, visit: