Does My Medical Insurance Cover Psychotherapy?
This question has so many answers based on what type of insurance policy different people have. So the easiest way to answer it for everyone is to explain a bit about how insurances work for therapy and some of the common terms and types of insurances that people tend to have.
Some Basic Insurance Terms
First off, let’s define some basic insurance terms, if you know all of these, please feel free to skip ahead to the next paragraph.
HMO – Health Maintenance Organization plans are plans that you have a “primary care” doctor who refers you to specialists if necessary. They tend to have very good “in-network” coverage, and very little or no “out-of-network” coverage.
PPO – Preferred Provider Organization plans are plans that allow you to go straight to any doctor without need for referral, and have both “in-network” providers and “out-of-network” providers.
EPO – Exclusive Provider Organization plans are plans that allow you to go straight to a doctor without prior referral, but only covers in-network providers.
Provider – Any licensed person providing care
In-Network – Provider who has an agreement with an insurance company to accept a contracted rate for care.
Out-Of-Network – Provider who charges the client and the client bills there insurance for reimbursement.
Superbill – the bill that patients submit to their insurance company for reimbursement.
Single Case Agreement – Out of network agreement, for a single case with an HMO or EPO (very rare).
Co-Pay – The amount you are required by your insurance company to pay at the time of service.
Deductible – The amount you are responsible for, and must meet with all providers before your insurance covers the remaining costs (this can get complicated so ask our biller about more details).
Insurance Coverage Depends
Back to the original question about if my medical insurance covers psychotherapy/counseling, the simplest answer is, it depends.
Some therapists are on panels (in-network) with insurance companies, which means, that if you see them, you are only responsible for your co-pay amount determined by the insurance company. These therapists tend to be very busy, and receive a low reimbursement rate for their services from the insurance companies. These are most common within HMOs and EPOs.
Other therapists, like us at Coherence Associates Inc., are not on any panels, and are accepted as an out-of-network provider. These therapists can give a bill to any client, the client can then submit this bill to their insurance company for reimbursement. These are most common for PPO’s, though often you cannot get reimbursed until after you have met your deductible.
Other Therapists are cash-pay only, but most will give you a bill to submit to your insurance.
Fee-For-Service and Superbills
At Coherence Associates, Inc. we have always been a primarily fee-for-service based company. This means that clients pay at the time of service. We can give clients superbills to submit to their insurance for whatever reimbursement they can get. However, if your therapist is an "Associate" or pre-licensed clinician, then we cannot give a superbill, since associate clinicians are not covered by insurances until they are licensed. We are working with a few insurances to become in network so please look out for more information in the future.
Employee Assistance Programs for First Responders
We also are a specialized EAP with some cities, companies, and first responder agencies, these include but may not be limited to:
Carlsbad Police, City, and Fire.
San Diego Harbor Police
Oceanside Fire
Escondido Police
La Mesa Police
Heartland Dispatch
San Miguel Fire
Magellan for California Highway Patrol, California Border Patrol, Cal Fire, and California Department of Corrections
In-network Insurances
If your company, department, city, or agency would like to know more, please reach out to us.
Recently we have also started taking limited insurances in-network. We are currently in network with:
Cigna
We are working towards a limited selection of others, if you have questions please reach out to us.
If you have questions about insurance, rates, reimbursements, or anything else, please call us at (760) 942-8663, and we will do our best to answer all of your questions (and if we don’t know, we will try and find out).
By Jeremy Larsen
Co-Founder and Business Development
Coherence Associates Inc.
www.coherenceassociates.com
(760) 942-8663
