Understanding your mental health insurance benefits

Deciphering what mental health services your insurance covers can feel daunting. You may wonder how many talk therapy appointments are covered or worry about out-of-pocket costs. But whether you’re dealing with anxiety, depression, body image concerns, extreme stress, or other concerns, prioritizing your mental health is important — and it’s worth decoding your benefits.

How do you know if an insurance plan covers mental health?

Start by reviewing your plan’s summary of benefits and coverage to understand what’s covered and any associated costs. You can also call your insurance company’s customer service department and ask about this benefit information. Some mental health providers can do a benefits check for you to provide a snapshot of your benefits. 

Most health insurance plans cover mental health and substance use treatment, but the extent of coverage varies based on your insurance type, state of residence, and specific plan details.

If you’re signing up with a new insurer during open enrollment and want a plan that covers mental health services, follow these steps:

• Research available plans. Explore your employer’s benefit plans or your state’s healthcare insurance marketplace to compare options. Look for coverage listed under “behavioral health” or “mental health services.”
• Assess your needs. Identify the type of mental health services you may need, such as talk therapy, medication, or inpatient care. Consider whether ongoing therapy, medication, or specialized treatment is necessary.
• Contact your insurer. If you have additional questions about benefits, exclusions, or requirements, call the insurance company’s customer service department for clarification.
• Confirm coverage start dates. Learn when your mental health benefits begin and if you need a referral from your doctor or a preauthorization before making an appointment. This information should be in the plan’s description of benefits.
• Evaluate costs. Understand your budget for health insurance and potential out-of-pocket expenses. For example, check if the plan limits the number of covered therapy sessions or includes copays or deductibles for care.

Must-know insurance lingo

Insurance companies often use industry jargon, making it harder to understand your mental health benefits. Here are some common terms explained:

• Behavioral health: This umbrella term includes mental health, substance use, and habits affecting well-being, like diet, exercise, and sleep. 
• Copay: This is the fixed out-of-pocket amount you pay for a therapy visit.
• Coverage limits: This includes restrictions on services your insurer will pay for, like allowing only 10 therapy sessions per year before out-of-pocket costs apply.
• Deductible: A deductible is the amount you pay out of pocket before your insurance begins covering costs.
• Evidence of coverage (EOC): An EOC is a detailed document outlining your plan’s benefits, restrictions, prescription coverage, and how to access care. This is typically available through your employer, insurer, or the Health Insurance Marketplace.
• Explanation of benefits (EOB): An EOB is a statement from your insurer breaking down treatment costs, what they paid, and what you owe.
• In-network providers: This list includes doctors and therapists contracted with your insurer to offer lower-cost services.
• Mental health parity law: The federal parity law was passed in 2008, requiring insurance coverage for mental health, behavioral health, and substance-use disorders to be comparable to physical health coverage. For example, an insurance company can’t charge a $40 copay for mental health visits while charging only a $20 copay for medical or surgical office visits.
• Out-of-network providers: Mental health professionals who don’t have a contract with your health insurance plan are referred to as “out of network.” Your insurance company may not cover the cost of seeing an out-of-network therapist, or they may pay a portion of the expense.
• Preventative care: This type of mental healthcare focuses on identifying and managing stressors before they escalate into larger issues. 
• Prior authorization: Some treatments require prior authorization, meaning you must get your insurer’s approval before starting them.

How to read your mental health benefits

You may have questions about the specific mental health benefits your insurer covers. Common concerns include:

• Services covered: Does your plan include therapy? Are there limits on the number of sessions? Does it cover teletherapy, in-person visits, or both?
• Possible exclusions: Some insurers may exclude certain mental health conditions or treatments. Coverage might require a formal diagnosis and may not extend to experimental therapies that aren’t deemed “evidence-based,” or alternative treatments like hypnotherapy or holistic approaches.
• Medications: Are prescribed medication covered under your plan? What will they cost?
• Getting started: Does your insurer require a physician referral to see a therapist, or can you book an appointment directly? Do you need to choose an in-network provider, and what are the costs if you see someone out of network?

What to do if you’re unhappy with your insurance benefits

If you’re dissatisfied with your current insurer, you can switch health plans during your company’s open enrollment period, which typically occurs once per year in the fall. If you have insurance through your state’s health insurance marketplace, you can enroll in a new plan by Dec. 15 for coverage starting Jan. 1. 

In the event your health plan denies or limits coverage for mental health or addiction treatment, you have the right to file a complaint. Assistance is also available if you need help filing a claim in response to being denied coverage for treatment. 

Find care with Rula

Prioritizing your mental health can strengthen your relationships, boost your self-esteem, and improve your overall well-being. If you’re experiencing depression, anxiety, or substance use, navigating mental healthcare benefits shouldn’t stand in the way of getting the support you deserve.

At Rula, we believe everyone deserves affordable, effective mental healthcare. With a network of over 10,000 therapists, it’s easy to find a provider who accepts your insurance and can meet with you via live video sessions as soon as tomorrow. 

Find a therapist with Rula