Does Health Insurance Cover Therapists?
Health insurance plans may offer coverage for therapists, whether you’re seeking therapy for physical or mental health issues. Each policy has its own set of rules and the amount and type of coverage depends on your specific plan.
Your policy may also have a list of requirements you must meet before any type of coverage goes into effect. Additionally, you may need a referral from your primary care doctor or other health care professional to be eligible for your plan’s coverage.
What types of therapists help with physical issues?
If you need help with physical issues, your choice of therapists includes physical therapists, occupational therapists, and recreational therapists. The goal of a physical therapist is generally to help you recover from an illness or injury, according to the U .S. Bureau of Labor Statistics.
Physical therapists can design a physical exercise plan that helps you target problem areas to improve your range of motion and movement. They can also help with pain management.
Occupational therapists help people learn or re-learn how to do daily tasks, such as dressing themselves, eating, and other necessary activities. Those with illnesses, injuries, or physical disabilities can often benefit from an occupational therapist.
The goal of the recreational therapist is to help those with illnesses or disabilities engage in recreational activities. The therapists can design and coordinate individualized programs using any type of recreational activity that can contribute to a person’s mental and physical well-being. Activities can include sports, dance, games, art, field trips, and other events that enhance a person’s overall wellness.
What about therapists for mental health?
On the mental health side of things, the term therapist is a general one that can describe various mental healthcare providers. Therapists may be psychiatrists, psychologists, social workers, or counselors.
Psychiatrists hold medical degrees and are qualified to prescribe medication. CNN notes that they are also usually the type of therapist to see for severe mental health issues such as schizophrenia or bipolar disorder.
Psychologists hold doctorate degrees and, although they cannot prescribe medication, they can refer patients to psychiatrists if they feel medication would be a helpful component in a person’s treatment program.
Social workers and counselors do not necessarily hold doctorates, but they may have a master’s degree in their specific field of study. They are usually the least expensive therapist and health insurance plans with limited benefits may only cover counselor or social worker visits.
What stipulations might I have to follow?
In addition to the possibility of having a referral for a therapist, the American Academy of Child and Adolescent Psychiatry notes a number of issues to address before you even schedule a visit. Your plan may have a list of preferred providers in a network that you must see if you want your visits to be covered. You may have the option of going outside of the network, but your insurance company may not cover any of the cost.
You may also have to meet your annual deductible by paying out of your own pocket before your health insurance plan starts to cover the visits. Your plan may also have a strict limit on the number of visits you’re allowed per year or through the lifetime of your plan.
Finding out how the billing works is another important factor. You need to know if your therapist deals directly with the insurance company or you have to act as a middle man and send in the reports.
If your treatment involves medication or services above and beyond office visits, you may again have to meet a deductible or only have limited coverage for such services. You also want to find out how much you will be charged per visit for your co-pay and if your therapist has a set fee or uses a sliding fee scale.
Certain conditions or pre-diagnosed conditions may not be covered. Your insurance company may also have limitations on what types of treatments are covered.
For instance, occupational therapy to help people with disabilities learn to eat on their own may be covered because the insurance company deems eating a necessary activity. Occupational therapy to help people with disabilities learn to drive a car on their own, however, may not be covered if the insurance plan doesn’t define driving as a necessary activity. Reviewing the definitions in your plan is a must as each plan can have vast differences.
Reviewing what you do if you are not happy with a provider is another important move. This is especially important when it comes to a mental healthcare provider.
The success of mental health therapy depends largely on your relationship with your therapist. The person needs to be someone you can trust and who makes you feel comfortable. You’ll want to know what type of changes your plan may allow once you’ve already begun treatment or if any changes are even allowed.