Does Insurance Cover Online Therapy? Complete Breakdown 2024

Does Insurance Cover Online Therapy? Complete Breakdown 2024

Short answer: Yes, most insurance plans now cover telehealth mental health services. But coverage varies widely. Here's everything you need to know.

Recent Changes: The Telehealth Revolution

Before COVID-19

• Only 20% of insurers covered telehealth therapy
• Required in-person establishment of care first
• Limited to specific diagnoses
• Often required separate copays

After 2020

• 90%+ of insurers cover telehealth
• Parity with in-person therapy (same coverage)
• No prior in-person requirement
• Many states made changes permanent

Bottom line: Your insurance probably covers online therapy now, but details matter.

Understanding Your Mental Health Benefits

Key Terms You Need to Know

Behavioral Health Coverage

• Mental health and substance abuse services
• Separate from medical coverage
• May have different deductibles/copays

Parity Laws

• Mental health coverage must equal medical coverage
• Same deductibles, copays, and limits
• Federal law since 2008 (Mental Health Parity Act)

In-Network vs Out-of-Network

• In-network: Higher coverage (70-100%)
• Out-of-network: Lower coverage (50-70%)
• Significant cost difference

Types of Coverage

1. HMO (Health Maintenance Organization)

• Must use in-network providers only
• Need referral from primary care
• Lower out-of-pocket costs
• Less flexibility

2. PPO (Preferred Provider Organization)

• Can see out-of-network providers
• No referral needed
• Higher premiums
• More flexibility

3. EPO (Exclusive Provider Organization)

• Must use in-network (except emergencies)
• No referral needed
• Moderate premiums
• Some flexibility

4. High-Deductible Health Plan (HDHP)

• Lower premiums
• High deductible ($1,500-7,500)
• HSA eligible
• Can use HSA for therapy

How to Check Your Coverage

Step 1: Find Your Mental Health Benefits

Call the number on your insurance card: "I'd like to understand my mental health benefits for telehealth therapy."

Ask these specific questions:

• "Do you cover telehealth therapy sessions?"

• "What's my copay for therapy?"

• "How many sessions are covered per year?"

• "Do I need pre-authorization?"

• "Does telehealth have the same coverage as in-person?"

Step 2: Verify with the Provider

Before your first session:

• Confirm they're in-network
• Ask about billing practices
• Understand their cancellation policy
• Get fee schedule in writing

Step 3: Get It in Writing

Request:

• Explanation of Benefits (EOB)
• Pre-authorization if required
• Written confirmation of coverage

Major Insurance Providers: Coverage Breakdown

Blue Cross Blue Shield

• Average copay: $25-40
• Sessions: Usually unlimited
• Note: Varies by state and plan

UnitedHealthcare

• Average copay: $20-50
• Sessions: 20+ typically
• Optum network included

Aetna (CVS Health)

• Average copay: $25-45
• Sessions: Varies by plan
• Crisis services covered

Cigna

• Average copay: $20-40
• Sessions: Typically unlimited
• 24/7 crisis line

Kaiser Permanente

• Copay: $15-30 (usually lower)
• Sessions: Comprehensive
• Must use Kaiser network

Medicaid

• Varies significantly by state
• May have provider shortages
• Retroactive enrollment possible

Medicare

• 20% coinsurance
• No session limits
• Part B deductible applies

Major Online Therapy Platforms: Insurance Acceptance

Platforms That Accept Insurance

Talkspace

• Partners with 40+ insurers
• Direct insurance billing
• Easier than out-of-network reimbursement
• Check if your plan is included

Cerebral

• Accepts many major insurers
• Medication + therapy coverage
• Insurance verification upfront
• Growing network

MDLive

• Broad insurance acceptance
• Often covered as regular medical visit
• Quick insurance verification
• Lower copays typical

Teladoc

• Extensive insurance partnerships
• Often through employer benefits
• May be $0 copay
• Video and phone options

Amwell

• Many insurance partners
• Part of hospital systems
• Good insurance integration
• Same-day appointments

Platforms That Don't Take Insurance (Usually)

BetterHelp

• Subscription model ($60-90/week)
• Can submit for out-of-network reimbursement
• May get 50-70% back
• More hassle but possible

Headway

• Connects you with in-network therapists
• Handles insurance billing
• Find covered therapists easily
• Growing availability

Out-of-Network Reimbursement

If your therapist isn't in-network:

How It Works

• Pay therapist upfront (full session cost)
• Get superbill (detailed receipt with diagnosis codes)
• Submit claim to insurance
• Get reimbursed (typically 50-70%)

Steps to Get Reimbursed

1. Verify out-of-network benefits

• Call insurance: "What's my out-of-network mental health coverage?"
• Ask about deductible and coinsurance
• Confirm submission process

2. Collect required documents

• Superbill from therapist (must include):

3. Submit claim

• Online portal (fastest)
• Mail form with superbill
• Keep copies of everything

4. Follow up

• Processing takes 2-6 weeks
• Check claim status online
• Appeal if denied

Typical Reimbursement Rates

• Excellent plans: 70-80% after deductible
• Good plans: 50-60% after deductible
• Limited plans: 40-50% or not covered

Deductible matters: If you have $3,000 deductible, you pay 100% until that's met, then coinsurance kicks in.

Costs Without Insurance

Average Costs

Individual therapy:

• In-person: $100-250/session
• Online platforms: $60-100/week ($240-400/month)
• Community clinics: $30-80/session (sliding scale)
• University clinics: $20-50/session

Psychiatry (medication management):

• Initial: $200-500
• Follow-up: $100-300
• Online platforms: $85-150/month

Group therapy:

• In-person: $40-80/session
• Online: $20-60/session

How to Make It Affordable

1. Sliding scale therapists

• Pay based on income
• Search: "sliding scale therapy [your city]"
• Many private therapists offer this

2. Community mental health centers

• Federally funded
• Income-based fees
• Comprehensive services
• Find at: SAMHSA.gov

3. Training clinics

• Graduate students (supervised)
• $20-60/session
• Good quality care
• Local universities

4. Employee Assistance Program (EAP)

• 6-8 free sessions typically
• Through your employer
• Confidential
• Check HR for details

5. Online therapy subscriptions

• BetterHelp: $240-360/month
• Talkspace: $276-396/month
• Cheaper than traditional
• More accessible

6. Support groups

• NAMI: Free
• DBSA: Free
• AA/NA: Free
• Peer-led support

Special Situations

Employer-Sponsored Plans

Check for:

• EAP benefits (free sessions)
• Telehealth additions (some employers added during COVID)
• Wellness benefits
• HSA/FSA contributions

Ask HR:

• Mental health benefits summary
• Telehealth coverage
• In-network directories
• Additional resources

Student Health Insurance

College/University plans:

• Often include counseling center access
• May have limited sessions
• Telehealth usually covered
• Check student health services

Marketplace Plans (ACA/Obamacare)

• Must cover mental health (essential health benefit)
• Telehealth widely covered
• Subsidy may help with premiums
• Compare plans at Healthcare.gov

TRICARE (Military)

• Covers telehealth therapy
• Active duty and dependents
• Some limitations on platforms
• Check TRICARE.mil

What If Your Claim Is Denied?

Common Denial Reasons

• Out-of-network provider → Check if you have OON benefits
• No prior authorization → Get retro-authorization
• Not medically necessary → Appeal with doctor support
• Wrong diagnosis code → Therapist can correct
• Incomplete information → Resubmit with full details

How to Appeal

Step 1: Understand why

• Read denial letter carefully
• Identify specific reason
• Note appeal deadline

Step 2: Gather evidence

• Letter from therapist (medical necessity)
• Treatment plan
• Progress notes
• Research supporting treatment

Step 3: Submit appeal

• Written appeal letter
• Include all documentation
• Send certified mail
• Keep copies

Step 4: Escalate if needed

• Internal appeal first
• External review if denied again
• State insurance commissioner complaint
• Consider legal help for large amounts

Success rate: 40-50% of appeals succeed. Don't give up.

Using HSA/FSA for Therapy

Health Savings Account (HSA)

✅ Can use for:

• Therapy copays
• Out-of-pocket therapy costs
• Psychiatric medication
• Mileage to appointments

❌ Cannot use for:

• Insurance premiums (usually)
• Services not yet provided

Flexible Spending Account (FSA)

Same as HSA, but:

• "Use it or lose it" by year-end
• No carryover (usually)
• Often lower limits

Dependent Care FSA

• Can cover therapy for dependents
• Child therapy included
• Different rules than medical FSA

Red Flags: Insurance and Therapy

⚠️ Be cautious if:

Therapist wants to:

• Bill for services not provided
• Use incorrect diagnosis codes
• See you more often than necessary
• Refuse to provide superbills

Insurance company:

• Denies all mental health claims
• Requires unreasonable authorization
• Changes benefits mid-year without notice
• Doesn't follow parity laws

Report violations to:

• State insurance commissioner
• U.S. Department of Labor (employer plans)
• CMS (Medicare/Medicaid)

The Bottom Line

Most insurance now covers online therapy with the same benefits as in-person.

To maximize your benefits:

• ✅ Verify coverage before starting
• ✅ Use in-network providers when possible
• ✅ Keep detailed records
• ✅ Know your rights under parity laws
• ✅ Appeal denials
• ✅ Consider all affordable options

Don't let insurance confusion stop you from getting help. Resources exist regardless of coverage.

Take Action Today

• Call your insurance → Ask the 5 key questions
• Get provider list → Find in-network therapists
• Verify coverage → Confirm with therapist before first session
• Start therapy → Your mental health is worth it

Remember: Therapy is healthcare. Your insurance should cover it. If you're having trouble, advocates and resources can help.

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This guide is educational. Insurance coverage varies. Verify your specific benefits.