What are the costs of therapy with insurance?

How to find out how much therapy costs with your insurance

Insurance can be confusing sometimes. If you are trying to get more information on what therapy will cost when using your insurance—read more below about how to contact your insurance company and questions that are helpful to ask.

Finding contact information for your insurance company

You can find the phone number for your insurance company on the back of your insurance card. You will use this number to call and determine your insurance benefits. Most insurance companies also have their own customer insurance portal that you can access on their website. You can often verify your insurance benefits for therapy on their portal as well.

Is your therapist in-network with your insurance?

When you contact your insurance company ask if the therapist you are hoping to see is in-network with your insurance. In-network means that the therapist accepts your insurance and can bill in-network benefits on your insurance policy.

• You can often lookup your provider on your online insurance portal to determine if they are in-network. For example, if you have Blue Cross Blue Shield of Michigan—they have a “Find Care” feature where you can type in your therapist’s name.

If the insurance representative indicates that the therapist is out-of-network, it is helpful to ask if you have out-of-network benefits. Out-of-network means your therapist is not contracted with your insurance company. Though, your clinician may be able to provide you a superbill that applies to your out-of-network benefits. A superbill is essentially a receipt of your payment for therapy services— that you submit to your insurance company for reimbursement.

Questions to Ask

• Is ___________ therapist in-network with my insurance policy?

  • If not, what are my out-of-network benefits?

    • Do I have to meet a deductible before insurance will reimburse me?

    • Are there any limitations to what insurance will reimburse?

  • If yes—the therapist is in-network with my insurance. What are my in-network benefits?

    • Do I have to meet my deductible before my copay/co-insurance applies?

      • If yes, how much is my deductible? How much of my deductible has already been met?

      • What is my copay? or co-insurance?

Determining if specific therapy services are covered by your Insurance

It can be helpful to identify if the specific therapy billing codes (services) are covered by your insurance. Below are the billing codes that are most commonly used at Create Wellness Counseling LLC

• First Appointment

  • 90791: Psychotherapy Intake

• Follow-up Appointments

  • 90837: Individual Session 53+minutes

  • 90834: Individual Session 45 minutes

  • 90832: Individual Session 30 minutes

On some insurance provider’s website, you can look up these codes to determine your costs. For example, on the Blue Cross Blue Shield of Michigan insurance portal you can look up these codes on the “Procedure Cost Estimates” page of their insurance portal.

Questions to Ask

• Does my insurance cover the following CPT codes?

  • 90701

  • 90837

  • 90834

  • 90832

• Does my insurance cover Telehealth appointments?

  • At Create Wellness Counseling, Courtney currently only sees patients virtually (via Telehealth).

Identifying your costs

Knowing whether you have in-network benefits—and what your copay/co-insurance and deductible amounts are— can help estimate costs for therapy with your insurance.

Deductible with copay: Someone with a deductible, may have to meet their deductible prior to co-insurance or copay kicking in. For example, someone who has a $500 deductible and $20 copay.

• They may have to pay the full amount for each therapy session until they reach the $500 deductible. After they reach the $500 deductible, they would have a $20 copay for each therapy session.

For some insurance plans/policies— the deductible does not apply to certain CPT codes and office visits.

Questions to Ask

• Does my deductible apply to psychotherapy visits and _____ billing code?

Options if using Insurance is unaffordable

Depending on your insurance benefits, using your insurance may not be the most affordable option for you. Below are some resources to consider if you are thinking of not using your insurance due to affordability.

• Sliding Scale. Some clinicians offer a sliding scale, where the cost per session is adjusted based on a patient’s income. Therapists often have limited spots on their schedule for patients who utilize their sliding scale option.

• Local Universities and Colleges. Counseling programs at Universities and Colleges often have a counseling centers on campus where student therapists provide services at low-cost. Student therapists are being supervised by an experienced licensed clinician. These services may be time-limited due to the academic calendar of the university or college.

• Interns. Therapy practices and organizations may have interns working at their location who offer therapy services at a lower cost. Interns are often at the end of their clinical education and are being supervised by an experienced licensed therapist.

• Open Path Collective. Open Path Collective is an organization that hosts a directory of therapists that provide services at a lower cost. Sessions range from $30-$70. They also require a $65 one-time membership fee.

• Free & Charitable Clinics of Michigan (FCOM). A website, where you can find clinics that provide free or low-cost healthcare in Michigan.

Communication with your Provider

If you have questions or concerns regarding costs for therapy, please talk with your clinician. At Create Wellness Counseling—I will try verify to your insurance benefits after receiving your intake paperwork. I will not know for sure what your insurance will pay towards your sessions, until I file the first claim after your intake appointment.

I encourage you to verify your own benefits. Ultimately, it is your responsibility as the insurance policy holder to know your benefit coverage.