Guide to Checking Your Benefits

Therapy provides a valuable resource for individuals seeking support and guidance on their journeys of self-discovery and healing. Mental health insurance, also known as behavioral health insurance or psychiatric insurance, is a type of health insurance that specifically covers mental health and substance use disorder treatment. It is designed to provide financial assistance for individuals seeking therapy and other mental health services. Ultimately, knowing your insurance and benefits is the patient’s responsibility.  If you have questions about coverage, you will need to contact your insurance company directly.

Mental health insurance coverage typically includes provisions for therapy services. These services can range from individual therapy to group therapy, couples counseling and family therapy.

Mental health insurance often covers a wide range of therapeutic approaches and modalities. This can include cognitive-behavioral therapy (CBT), psychodynamic therapy and mindfulness-based therapy.

Does Insurance Cover Therapy?

Whether insurance covers therapy is a common concern for individuals seeking mental health support. While the answer can vary depending on your specific insurance plan, there are factors to consider when determining if Massachusetts counseling insurance covers therapy:

• Mental health parity laws: Mental Health Parity Laws, both at the federal and state levels, require insurance companies to provide equal coverage for mental health services as they do for medical and surgical services.
• Insurance plan coverage: The coverage for therapy services can vary depending on your insurance plan. This coverage may extend to various types of therapy.
• Pre-authorization and referrals: Some insurance plans may require pre-authorization or referrals from a primary care physician before accessing therapy services.

Mental Health and Therapy Benefits in Massachusetts

The mental health insurance coverage in Massachusetts contains the mental health parity law. The law ensures that insurance coverage for health insurance in Massachusetts offers equal coverage for mental health and substance use disorder services as they do for medical and surgical services. The law prohibits insurers from imposing greater financial or treatment limitations on mental health services than physical health services.

Regarding insurance coverage for therapy in Andover MA, Massachusetts law mandates that insurance plans cover a minimum of 20 outpatient visits for mental health services per year without requiring prior authorization. This provision ensures that individuals can access a reasonable number of therapy sessions without unnecessary administrative hurdles.

Types of Insurance Plans

Take the time to research and compare the coverage options that align with your needs and financial situation. Your mental health matters and having appropriate insurance coverage can significantly affect your ability to seek the help you deserve.

• Employer-based insurance: Many individuals receive insurance coverage through their employers. These plans often include provisions for mental health services, including therapy and counseling. Some plans may have limitations or require choosing from a network of approved providers.
• Private insurance: If you don’t have access to employer-based insurance, purchasing your own private insurance plan is another option. Private insurance plans vary in coverage for mental health services, so review the policies offered by different providers carefully. Look for plans explicitly mentioning mental health coverage and consider the specific terms.
• Government-funded insurance programs: Government programs like Medicaid and Medicare offer mental health coverage to eligible individuals. Medicaid is designed to support low-income individuals and families, while Medicare serves people aged 65 and older. These programs typically cover therapy and other mental health services but understand each has specific criteria for eligibility.

In-Network vs. Out-of-Network Providers

Choosing between in-network and out-of-network providers is a personal decision influenced by your financial circumstances and therapy preferences. While in-network providers generally offer more favorable coverage, out-of-network options may still be viable, depending on your situation. Prioritize open communication with your insurance provider and therapist to ensure you clearly understand the costs and benefits associated with each choice.

1. In-network providers: These are health care professionals who agree with your insurance company to provide services at negotiated rates. Benefits include your insurance company being more likely to cover a significant portion of the therapy costs and reducing out-of-pocket expenses. Secondly, in-network providers are familiar with the insurance company’s billing and documentation requirements, ensuring a smoother reimbursement process.
2. Out-of-network providers: Conversely, out-of-network providers do not have agreements with your insurance company. When you choose an out-of-network provider, your insurance coverage may be limited or differ from in-network providers. Insurance companies often reimburse out-of-network therapy at a lower percentage, requiring you to pay a higher portion.

Types of Payment for Therapy

Carefully review your insurance policy or speak with your insurance provider to understand the details of copayments, deductibles, coinsurance and maximum out-of-pocket limits for therapy services. Knowing these terms will empower you to plan your budget effectively and make informed decisions about your mental health care:

1. Copayment (copay): A copayment, commonly known as a copay, is a fixed amount you pay out of pocket for each therapy session. This payment is typically set by your insurance company and may vary depending on your specific plan.
2. Out-of-pocket costs: These costs include deductibles, coinsurance and any amount that exceeds your insurance coverage. Deductibles are the predetermined amount you must pay before insurance coverage kicks in. Once you reach your deductible, your insurance company will typically cover a percentage of the therapy costs, while you are responsible for paying the remaining coinsurance.
3. Deductible: A deductible is the amount you must pay out of pocket. For example, if your insurance plan has a $500 deductible, you will be responsible for paying the first $500 of therapy costs before your insurance starts contributing. It’s important to note that deductibles vary between insurance plans and may differ for in-network and out-of-network providers.
4. Coinsurance: Coinsurance is the percentage of therapy costs that you are responsible for paying after you’ve met your deductible. For instance, if your insurance plan has a 20% coinsurance, your insurance company will cover 80% of the therapy costs and you’ll be responsible for the remaining 20%. Coinsurance is typically applicable once you’ve reached your deductible and can continue until you reach your maximum out-of-pocket limit.
5. Maximum out-of-pocket limit: Your insurance policy may include a maximum out-of-pocket limit, which is the maximum amount you must pay in a given year for covered services. Once you’ve reached this limit, your insurance company will typically cover 100% of the remaining therapy costs for the year. Understanding your maximum out-of-pocket limit can provide peace of mind, knowing there is a cap on your financial responsibility.

How to Know if Your Insurance Covers Therapy

Navigating insurance coverage for therapy can sometimes feel overwhelming, but with a step-by-step approach, you can clarify what your insurance plan includes:

1. Review your insurance policy documents: Begin by thoroughly reading your insurance policy documents. Look for sections that mention mental health coverage, therapy, counseling or behavioral health services.
2. Contact your insurance provider: If you have questions or need clarification after reviewing your policy, contact your insurance provider’s customer service. Prepare a list of specific questions about therapy coverage.
3. Inquire about in-network providers: Ask your insurance provider for a list of in-network therapy providers. In-network providers have agreements with your insurance company, often resulting in more favorable coverage.
4. Verify coverage for out-of-network providers: If you prefer to see a therapist not in your insurance company’s network, inquire about the coverage for out-of-network providers. Ask about reimbursement rates, any documentation or pre-authorization requirements and the percentage of costs you would be responsible for paying.
5. Seek clarification on session limits: Some insurance plans impose session limits for therapy services. Inquire about any restrictions on the number of therapy sessions covered per year and if there are any exceptions or extensions available.
6. Document conversations and keep records: Throughout communication with your insurance provider, keep detailed notes, including the names of representatives, dates and key points discussed. This documentation will serve as a reference in case of any discrepancies or future inquiries.

What to Do if You Have Questions About Your MV Psych Billing

• If a patient has a question about a bill they receive: we are always happy to speak with them and provide clarification for their billing.  However, we are required to bill whatever the insurance company tells us to.
• If the insurance company denies an insurance claim, or if they only cover some of the cost: the responsibility of cost falls to the client.  We only bill clients based on what the client’s insurance company instructs us.
• If you feel a session should have been covered and wasn’t: please contact your insurance company.
• If the insurance company decides to cover a denied claim: clients will need to inform our billing department and provide a reference number and the name of the associate you spoke with so that we can resubmit the claim on your behalf.

At this time, we are in-network with Blue Cross Blue Shield and OPTUM/United Healthcare/United Behavioral Health.  We also accept private pay.  If you have out-of-network coverage for your insurance plan, our practice may be able to see you.  That said, you will need to contact your insurance company to confirm.  This is the responsibility of the patient to know.

Insure Your Mental Wellness and Claim a Happier You!

Merrimack Valley Psychological Associates is here to guide you through the twists and turns that life throws at you. Our counseling center in Andover, Massachusetts, is dedicated to supporting individuals and families facing various challenges.

At Merrimack Valley Psychological Associates, we understand that seeking therapy can be intimidating. That’s why we offer the flexibility of teleconferencing services from the comfort of your home or the option to meet with us in our inviting Andover office.

If you’re searching for experienced and caring psychologists, don’t hesitate to reach out to Merrimack Valley Psychological Associates today. Let us be your trusted guides on your mental and emotional well-being journey.

Reviewed By

Dr. David Rainen, PsyD. 

I am a licensed clinical psychologist with an extensive background treating a variety of different ages, situations, emotional and mental health disorders in individuals and their families.  As part of my 10 year professional and training career in psychology, I have developed and refined my skills and approaches through my work in a variety of diverse settings including: hospitals, community outpatient facilities, college counseling centers, secure and unsecure inpatient/residential treatment programs, and therapeutic day schools.