Should I Use My Health Insurance for Therapy?

When you decide to see a licensed psychologist for therapy, you will have some choices to make about whether to use your health insurance if you have coverage. If your problem is serious and you cannot get treatment without the coverage, then the down side of using insurance is less important than the help you might get on a serious issue. In order to use insurance, it must be considered medically necessary and you will receive a diagnosis. Certain kinds of issues will not be covered with health insurance. For example, marriage counseling is rarely covered by insurance and many insurers will not cover issues related to education such as an evaluation for attention deficit disorder or learning disability.

If you are planning to apply for private insurance (disability or life insurance outside of group policies), the diagnosis and treatment you receive may leave you not insurable in the private market or you may find the cost is significantly higher than it would have been without the mental health history that is now attached to your record. Beginning in 2014 with the Affordable Care Act, health insurers will no longer be allowed to underwrite based on medical condition. This means that in Jan 2014 they will not be allowed to charge more for your health insurance because you have had treatment for depression. Disability and life insurance may still be affected even if health insurance will not. Under the new laws, treatment for mental health conditions must be covered and can no longer be “carved out” of a health insurance plan with higher deductibles and restrictions on treatment.Unfortunately many consumers do not know that this is already in effect through the Mental Health Parity act and my colleagues have seen rampant abuses and instances of the law being broken when insurance companies have continued to place restrictions on mental health benefits that are not seen on medical benefits. If your family physician is allowed an unrestricted number of outpatient medical visits during the calendar year, then under the parity law, a therapist must also be allowed unrestricted outpatient medical visits.

In large metro areas, you might find that the providers who do accept insurance tend to be a little younger and newer in practice. Many of them are excellent but if you particularly need an older or more experienced practitioner, many of us no longer accept insurance due to the stress involved in getting treatment approved and getting claims paid correctly. Although I no longer file or belong to insurance panels, you may still be eligible for an out of network reimbursement, depending on the plan you chose and what your company offers. Many companies provide generous out of network benefits but many do not. Check your particular plan by calling your customer service number on your card to see if you are eligible to use the out of network outpatient mental health benefit and what will be covered. Be a wise consumer and be sure that you understand your health insurance and the future impact of using it.

If you need to find a PhD provider who is part of your plan, please go to the Georgia Psychological Association website at and click on the button for the referral service. You can then search for a psychologist who does accept your plan.