TLDR: Even if a therapist does not accept your insurance, your insurance may still cover part of the expense of therapy. If you have a PPO insurance plan, you can submit therapy invoices (called superbills) as out-of-network claims and be reimbursed for part of the cost
It can be really hard to find a therapist who is the right fit and also in your insurance network. This is for a variety of good reasons. The main ones being insurance companies do not pay a livable wage in many areas (including Los Angeles and the South Bay), and they also place limits on care that are not in the client’s best interest. Pursuing private pay therapy often (but not necessarily) means higher quality care.
So how can you make it more affordable?
How do I find out if my insurance will pay for private pay therapy?
In general, if you have the choice to email or message your insurance company via their online portal instead of calling, I always recommend this for two reasons. It really minimizes wasted time spent on hold and dealing with frustrating phone trees and AI agents. But more importantly, it gives you their answer in writing, which is always, always helpful when dealing with insurance companies. If you can’t message them, then you’ll have to call the number on the back of your insurance card.
Either way, you’ll want to ask them the following questions:
Are out-of-network providers covered?
Does this include telehealth?
Do I have a deductible or other coinsurance I have to meet first?
Does therapy have to be preauthorized to be covered?
How much will I be reimbursed? The medical code for a 50-minute therapy session via telehealth is 90834-95. They will need this to give you a specific answer. If your sessions are in person, longer, or shorter, they may have a different reimbursement.
How do I submit an out-of-network claim?
Today, most insurance companies have a way to do this on their website, but every once in a while I run across one that requires snail mail and wet signatures!
When you contact your insurance company, ask them what their process is and then follow their guidance. Once you do it the first time, it is easier going forward.
I provide all my clients with a superbill, which is just a monthly invoice with all the additional information the insurance company needs to process the out-of-network claim (for example, the provider’s tax ID number, license number, diagnosis, etc.). You will submit this superbill to your insurance company along with any forms they ask you to complete.
Do I have to have a diagnosis?
Yes. If you want to have your therapy covered by insurance, they will require a diagnosis to demonstrate “medical necessity.” Insurance will not pay for therapy for your well-being, quality of life, or for prevention of a diagnosis. While this is total BS and not remotely health-enhancing, it is how it is.
What are other ways to save money on private-pay therapy?
If you have access to a Flexible Spending Account (FSA) or Health Savings Account (HSA), you can use these funds to pay for your therapy, and it will save you money on taxes! The way they work is that you set aside money into these accounts from your paycheck tax-free and then can use the funds to cover healthcare expenses, including therapy.
All healthcare, including therapy, is also tax-deductible at the end of the year, regardless of whether or not you submitted out-of-network claims.
I hope these tips help you get the most out of your insurance and save some money.
Start Therapy for Women in Los Angeles:
If you feel overwhelmed, stuck, or anxious and could use some support, working with a therapist who specializes in women’s issues and experiences can really help. Start by following these steps:
Reach out for a consultation at Well Woman Psychology.
Meet with a therapist specializing in women’s issues.
Release what is no longer serving you and live in greater alignment with your values
About the Author:
Dr. Linda Baggett is a licensed psychologist and founder of Well Woman Psychology, a virtual trauma-informed and fat-positive therapy practice specializing in women in California, Colorado, Illinois, New York, and Washington. Dr. Baggett helps women manage trauma, anxiety and relationship challenges so they can build the healthy, fulfilling relationships they deserve with less stress. She also works with clients around body image, relationship issues, perimenopause and menopause, perinatal and postpartum challenges, pregnancy loss and miscarriage, and infertility.
Disclaimer: This blog is for educational and informational purposes only, is not a substitute for individual medical or mental health advice, and does not constitute a client-therapist relationship.