Is Mental Health Therapy Covered by Insurance?
It’s not uncommon to put off your journey towards mental wellbeing simply because you don’t know where to start, what to ask, or what your options are. One of the most impending concerns you may have is whether you can afford therapy. Does your workplace insurance cover therapy? What therapeutic services are covered by your insurance provider?
As an intake specialist, I have experience guiding clients through their therapy process. I work alongside insurance providers and am familiar with what they expect from you as you maneuver your way through this process. I am also completing a master's in Counselling Psychology, and I know what qualifications and services are covered by most insurance companies.
Let’s peel back some of the layers and help you figure out if therapy is covered by your insurance provider, and how you can find out the type and amount of therapy coverage you have.
Does your insurance cover therapy?
The simple answer is, typically, yes. As mental health becomes more and more of a priority, most workplace and private insurance providers will offer coverage for therapy. There are, however, conditions to your insurance coverage for therapy that you should consider. These factors include:
- What services your therapist offers and what therapy coverage you have
- Where your therapist is located
- How much therapy coverage your insurance provides
What therapy coverage do I have?
Every insurance coverage package is different. It is important to do your due diligence before starting therapy so you don’t get stuck with unexpected out-of-pocket payments afterward. To ensure that therapy is covered by your insurance provider, you need to access your employer’s healthcare plan. You normally work directly with your insurance provider to inquire about and use your therapy benefits, but a good place to start is to ask your employer for your healthcare benefits booklet.
Your benefits package likely includes really specific services and titles. While “therapist” and “counsellor” may be terms you’re familiar with, your mental healthcare provider will usually cover more specific services. The two most common therapy services covered by insurance providers are psychological services and social work services.
To understand the difference between mental health care professionals and services, check out the article What Are the Different Types of Therapists?.
Once you know what mental health services your insurance package covers, contact the therapist you want to work with and make sure that the therapy services they provide line up with your insurance coverage.
It is also important to note that most insurance companies only cover therapists in the province or state you live in. If you’re looking for online therapy services, it is important to check that the therapist you’re working with is certified to work in your area.
How much therapy insurance coverage do I have?
You may also be wondering how much insurance coverage for therapy you have. You should contact your insurance provider to find out the amount of therapy they cover, and if they cover full session costs.
Some insurance providers only offer coverage for a percentage of the therapy session cost, while others cover full sessions. For example, your insurance provider may need you to pay for 25% of your session, while they pay the remaining 75%.
Other insurance providers cover full therapy session costs but cap the amount of therapy coverage you receive. In cases like these, they will outline how much overall mental health coverage you’re entitled to per year (this is called the “annual maximum”), and if you go over that amount, you will need to pay out-of-pocket.
It is important to note that insurance providers will not cover late cancellation or no-show fees. Talk with your therapist about their policies to avoid unexpected charges.
How does therapy insurance billing work?
While some therapy offices will deal with your insurance provider directly, most require you to pay upfront. After your session, your therapist will offer a receipt that should include:
- The therapist’s name (and sometimes, their supervising psychologist's name)
- Their professional title
- Their license number
- The services provided
- The session date and length
- The amount paid
You can use this receipt to submit a claim with your insurance. To do so, you need to call or email your insurance provider and pass along the receipt. The timeline for reimbursement depends on your insurance provider; contact them to ask when you can expect it.
Is therapy covered by OHIP?
Some mental health professionals are covered by the Ontario Health Insurance Plan (OHIP).
Psychiatrists and family doctors who practice psychotherapy are fully covered under OHIP. This means they will not cost you any out-of-pocket fees. Some psychologists and social workers working out of hospitals, or government-funded clinics and agencies, also offer OHIP-covered therapeutic services.
It is important to note that wait times for OHIP-covered mental healthcare professionals may be lengthy. Additionally, for psychiatrists, a referral from a general physician may be necessary.
Is KMA Therapy covered by insurance?
Our team at KMA Therapy includes registered psychotherapists and social workers who are all supervised by psychologists. As such, we are covered under psychological services, psychotherapeutic services, and social work services in Ontario.
If your insurance provider only offers one kind of therapy coverage, let us know! We will always try to set you up with a therapist that works not only with the issues you’re looking to address- but also with your financial needs!
Check out our article How Much Does Psychotherapy Cost? to find out how much you can expect to pay for therapy.
If you’re interested in booking a session, fill out the registration form below, and one of our client coordinators will be more than happy to help set you up with a session!
You can also book an intake session yourself on our booking page: Book Now.