May 30, 2025 • 17 mins
Therapy can be life-changing—but figuring out how to pay for it shouldn’t be a full-time job. In this episode of Her Time to Talk, we break down Insurance 101 for mental health care: what terms like deductibles, copays, F codes, and out-of-network really mean, and how they impact your care, cost, and confidentiality.
We also explore the real pros and cons of using insurance for therapy versus paying out of pocket—and how to know which option is right for you. Whether you're overwhelmed by your benefits, unsure what to ask your provider, or looking for reimbursement help, this episode is your guide to making therapy more accessible without sacrificing peace of mind.
Because your mental health matters—and you’re worth the care it takes to heal.
Topics We Cover in This Episode:
- What insurance really covers for mental health
- The difference between PPO, HMO, EPO, and other plan types
- Understanding deductibles, copays, and coinsurance
- Why your therapist needs to assign a diagnosis—and what that means
- What F codes and Z codes are (and why insurance only covers one of them)
- The difference between in-network and out-of-network therapists
- What a superbill is, and how out-of-network reimbursement works
- Confidentiality, diagnosis, and your permanent medical record
- Why many therapists don’t take insurance
- How to decide what’s right for your care, values, and budget
Resources Mentioned:
Connect with Us:
- Follow us on Instagram: @HerTimeToTalk
- Support the show on Patreon
- Subscribe, rate, and leave a review wherever you listen
- Share this episode with someone who’s ready to start therapy but unsure where to begin
Stay Connected + Support the Show
- Follow us @HerTimeToTalk
- Visit our website to connect with a therapist or learn more
- Become a patron and support the podcast
If this episode moved you, empowered you, or taught you something new—be sure to subscribe, leave a review, and share with someone who needs to hear it.
This is your time. Your story matters. Your voice is powerful. And your mental health is worth prioritizing.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Meagan (00:28):
Today we're talking about something super practical,
but also incredibly important.
Should you use your insurance topay for therapy.
We'll go over the real pros andcons of using insurance versus
paying out of pocket.
This is one of the most commonquestions that we get from
clients, and the answer reallyisn't one size fits all.
So whether you're starting yourtherapy journey or reevaluating
(00:50):
how to continue it, let'sexplore your options together.
Let's start with this.
Therapy can be life changing,whether you're dealing with a
serious mental health condition,or navigating the everyday
stressors of life, a breakup, anew job, grief, parenting,
trauma, you name it.
You don't really need to have aformal diagnosis to benefit from
(01:12):
having a therapist who listens,validates, and helps you sort
through what you're goingthrough.
Let's be honest.
As helpful as therapy can be,it's also an investment in your
time, energy, and finances.
So it's really natural to ask,how do I make therapy affordable
without creating even morestress in my life?
(01:33):
One option is to use yourinsurance benefits, but, and
it's a big, but that doesn'tmean it's the best option for
everybody.
Before we jump into the pros andcons of using insurance for
therapy, let's pause for a quickcrash course because let's be
real.
Insurance is confusing,especially when it comes to
behavioral health.
(01:53):
So here's the simplifiedbreakdown of how insurance
typically works when it comes totherapy.
Number one, your plan typematters.
You might have A-P-P-O-H-M-O orEPO or something else entirely.
PPOs usually allow for moreflexibility.
You can see out of networkproviders and may still get
(02:14):
partial reimbursement if you'reworking with a therapist that is
not credentialed to be part oftheir network.
An HMO often requires you tostay in network and may need a
referral from your primarydoctor in order to see another
provider within that system.
If this is the case, alwayscheck specifics with your
insurance company so that youreally know what type of plan
(02:36):
you have and what the boundariesof that plan are.
Number two is to know aboutdeductibles, copays, and
co-insurance.
A deductible is the amount thatyou pay out of pocket each year
before your insurance startscovering any medical services
and the cost of those services.
(02:57):
A copay is a flat fee that youpay per visit.
For example, this may be listedon your insurance card as paying
$20 per session.
Or$35 for an urgent care visit,or$50 for a specialist visit.
If this isn't listed on yourinsurance card and you're not
sure what your copay is, or ifyou have one, that's a great
(03:17):
question to call and ask yourinsurance company.
Then we have co-insurance.
This is when you pay apercentage of the session fee
after meeting your deductible.
So even if therapy is a coveredservice in your plan.
It may not be entirely free toyou.
It really depends on where youare in your deductible cycle.
(03:38):
For example, if you have ainsurance plan with a thousand
dollars deductible and a 10%co-insurance, you will have to
pay out of pocket a thousanddollars towards your medical
care, including therapy beforeyour insurance company starts to
cover any of those costs.
Once you have paid that athousand dollars deductible out
(04:00):
of pocket, you still have to pay10% of any medical costs after
that as part of thatco-insurance element of your
plan.
So if you're not quite surewhere you land with all of that,
what your deductible is, if youhave a co-insurance percentage
or if you have a copay, theseare great questions to call and
clarify with your insurancecompany.
(04:20):
as part of the insuranceverification process at her
time, we also have a greatbiller on staff who verifies
exactly what type of plan youhave, what coverage you have,
and what is gonna be requiredfrom you out of pocket.
We will also update you on yourdeductible amounts and how far
you have to go to meet yourdeductible before your insurance
jumps in to help cover the costof those therapy sessions.
(04:44):
The third thing you wanna knowabout is in network versus out
of network.
If a provider is in network,this means that your therapist
has a contract with yourinsurance company.
If your therapist is out ofnetwork, it means that they
don't.
You might still be eligible forreimbursement after paying out
upfront, but that's where superBills come in, which we'll talk
(05:05):
about a little bit later.
So whether your ideal therapistis in network or out of network,
it means a little bit ofdifferent things for how much is
going to be required for you topay out of pocket versus how
much your insurance company willcome in to help cover the cost,
either partially, completely, ornot at all.
(05:25):
The fourth thing to know aboutis session limits and
pre-authorization.
Some insurance plans limit howmany therapy sessions you can
have per year, or they may evenrequire pre-authorization,
basically asking permission inadvance to get care.
So always ask before starting anew medical treatment such as
therapy, are there any sessionlimits or preapprovals required
(05:47):
for this behavioral healthservice?
If so, you may need to talk withyour primary care physician and
get them to give you a referralso your behavioral health
sessions are covered by yourinsurance.
lastly, another important thingto know about when it comes to
insurance is confidentiality anddocumentation to get paid, your
therapist has to submitdocumentation to your insurance,
(06:10):
including your diagnosis andsome detailed notes.
We're gonna talk a bit moreabout this in just a moment, but
this is a crucial part of theconversation, when deciding if
it's right for you to useinsurance.
Alright, now that you've got thelay of the land, let's dive into
the actual pros and cons ofusing insurance for therapy and
why it works well for somepeople and not so much for
(06:31):
others.
Ready?
Let's go./
Let's start by looking at the pros of using insurance
to pay for your mental healththerapy.
First, and maybe most obvious,it reduces your out-of-pocket
cost.
If your insurance plan includesbehavioral health coverage and
you've already met yourdeductible, your sessions may be
all or partially covered thanksto something called parity laws.
(06:55):
Insurance companies are requiredto cover mental health
conditions similarly to how theycover physical health.
Your therapist and ouradministrative staff at her time
therapy are always happy to walkyou through what your particular
plan covers and what your copayand deductible might be.
Sometimes the savings are reallysignificant, especially if
(07:15):
you're looking for weeklytherapy sessions.
Second, insurance can improveconsistency in your care.
If therapy becomes moreaffordable through insurance,
this usually means you're gonnabe able to attend sessions
weekly instead of stretchingthem out to biweekly or once a
month.
This consistent rhythm helps youmake faster progress towards
(07:37):
your goals, and it gives yourtherapist a clear picture of how
you're doing from week to week.
And third, your copays can helpmeet your deductible.
If therapy is one of manymedical expenses that you're
managing, using insurance canactually get you closer to
meeting your medical deductible,which might save you money in
the long run if you have otherprocedures or medical situations
(07:59):
that you're gonna be in later inthe year.
Now let's take a moment to talkabout the cons of using
insurance to pay for yourtherapy sessions.
I wanna be really transparenthere because these are things
people don't often realize untilthey're really deep into the
process.
So number one, and this is abiggie, insurance requires a
(08:20):
diagnosis.
So in order for your therapistto submit a claim to your
insurance company and pay foryour session, your therapist has
to assign you a mental healthdiagnosis that qualifies for
treatment under your plan.
So what if you're seekingtherapy for something
situational like a breakup or ajob change?
These are very valid reasons fortherapy, and unfortunately, they
(08:43):
may not meet the criteria for aquote unquote formal mental
health disorder.
In those cases, therapists oftenuse what we call Z codes, which
cover challenges like stress orlife transitions, but aren't
really considered a pathologicalmental health disorder.
So what's the catch?
Insurance won't pay for Z codes,even if they are the most
(09:05):
appropriate code to assign youas a diagnosis for what's
happening in your life and whatyou're coming to therapy for.
Insurance companies only coverwhat we call F codes.
These are diagnoses, whichinclude disorders like major
depressive disorder, generalizedanxiety disorder, bipolar
disorder are post-traumatic.
Stress disorder and so on.
(09:27):
The more heavy hitting kind ofmajor disorders that insurance
tends to see as meeting medicalnecessity for therapy.
Ethically, therapists can't justgive you a more serious
diagnosis just to help you getreimbursed and to be able to use
your health insurance.
So this really puts us and youin a tough position.
If your symptoms don't meetclinical thresholds, your
(09:49):
insurance won't pay.
The second issue with usinginsurance to pay for your
behavioral health sessions isthat once you receive a formal
diagnosis, if that formal F codediagnosis is appropriate for
you, it does become part of yourpermanent medical record.
That means that if you apply forjobs requiring really in-depth
background checks, high levelsecurity clearance or even
(10:13):
things like life insurance, thatinformation and that diagnosis
may be accessible to theseorganizations for these type of
life situations.
that diagnosis could potentiallyimpact your eligibility or even
your rates on things likedisability coverage or life
insurance.
In some legal situations like adivorce or a lawsuit, your
(10:34):
mental health records can evenbe subpoenaed.
And what about employees at theinsurance company?
Let's think about that.
Insurance companies can chooseto audit therapists at any time
and request whatever clinicaldocumentation they want to
evaluate if the provider ismeeting their requirements to be
in network.
This means that your treatmentplan and the progress notes
(10:56):
written by your therapist afterevery session may be viewed as
part of the insurance auditingprocess by insurance company
staff.
Third, insurance companies havethe ability to limit your care.
To some degree, depending onyour plan, your insurance
company may decide things likehow long your sessions can be,
how many sessions you're allowedto have within a year or within
(11:19):
a certain time period and whichtreatment modalities they'll
reimburse.
So for example, if you need alonger session during a crisis,
or maybe you wanna exploresomething like yoga informed
trauma therapy or EMDR, whichtypically, takes a longer
session, like a 90 minutesession, your insurance might
(11:39):
not cover those type ofmodalities and those type of
sessions even though it's whatyour provider is recommending,
it's not what your insurancecompany has deemed as payable.
A fourth issue is that it can behard to find a therapist who is
in network who is actually agood fit for you.
This is especially true forclients utilizing Medicare or
(12:00):
Medicaid benefits, and we knowfrom research and experience
that the therapeuticrelationship is the number one
predictor of whether therapyworks and whether you're gonna
get better and reach your goals.
So finding the right therapistthat is a great fit for you and
has the right training andspecialty is really tough and
it's made even harder if you'rewanting to use your insurance
(12:22):
benefits and you have to onlywork with a therapist that is
considered in network.
Many great therapists eitherdon't accept insurance or aren't
paneled yet because the processis incredibly long, arduous, and
tedious.
Handling with insurancecompanies takes several months
of paperwork and is often socomplicated that an outside
credentialing specialist isneeded to guide that process.
(12:45):
That means that the therapistyou really click with might be
considered out of networkbecause they've simply decided
not to put themselves throughthat process.
Lastly, therapists are oftenpaid much less by insurance
companies than what they wouldearn through private pay.
It doesn't matter what yourtherapist charges out of pocket
for their private therapysessions if they are paneled
(13:06):
with insurance and you'resubmitting a claim to have your
insurance company pay for yoursessions, your insurance company
is the one who decides how muchyour therapist gets paid and
reimbursed for that claim, andthat rate is often much lower
than the amount your therapistreally needs to cover in order
to pay business expenses andpersonal expenses.
This doesn't really affect youdirectly, but it also does
(13:29):
impact your therapist'ssustainability and livelihood,
and that in turn affects thekind of care that they can give
and how accessible that they areto the people who need them.
So that's a lot to consider onthe pro side and the con side of
using therapy to pay for yourbehavioral health sessions.
you may be wondering is there athird option to just paying out
(13:50):
of pocket or using insurance?
And the answer is yes.
If you're stuck in between usinginsurance and paying fully out
of pocket, there is a middleground, which is out of network
reimbursement.
this is how it works.
You pay your therapist directlyat their out of pocket rate,
usually once a month they willprovide you with a document
that's called a super bill.
(14:11):
This looks a lot like an invoicethat lists the amount of
sessions that you've had duringthat month and how much you have
paid to the therapist and to thepractice for the sessions.
You then submit that super billdocument to your insurance
company and requestreimbursement for working with
an out-of-network provider.
depending on your plan, theymight reimburse you for all or
(14:32):
for part of that out-of-pocketcost.
It's not as seamless as using anin-network provider, but it
certainly gives you moreflexibility to work with the
therapist of your choice and theone that is the right match for
you.
due to the increasing difficultyof working with insurance, both
on the client side and theprovider side, companies like
Mania have started to pop up andexist specifically for this
(14:55):
purpose to help you, the therapyclient, submit super bills to
your insurance and to getreimbursement easier.
If you feel that this thirdoption might be right for you
and you wanna learn more aboutit.
We recommend visitingmanaya.com, and that's spelled
M-E-N-T-A-Y a.com, they are oneof the biggest and most popular
(15:16):
companies right now that aredoing great work to help clients
get reimbursement easier forthose that do have that out of
network option within theirplan.
At the end of the day, usinginsurance or not is a personal
decision.
It depends on your financialsituation, your goals for
therapy, your privacy concerns,and your values.
If using insurance is the onlyway that you'll get the support
(15:39):
you need, please use it.
Your mental health is moreimportant than a perfect system,
and if paying out of pocketgives you more freedom and peace
of mind, then that's totallyvalid too.
Just remember, therapy is aninvestment in you.
You live inside your head, inyour thoughts, in your emotions,
in your past and in your future,day in and day out.
(16:00):
Choosing to prioritize yourmental health.
However you do it is neverwasted.
If you're feeling empowered bytoday's episode, be sure to
subscribe and leave us a review.
You can also follow us on socialmedia at her time to talk for
more updates and tips.
(16:20):
And if you'd like to support theshow, consider becoming a
patron.
If you're ready to take the nextstep in your mental health
journey, visit her timetherapy.com and schedule a free
consultation with one of ourtherapists.
Thank you for taking the time totalk today.
Remember, your story matters.
Your voice is powerful, and yourmental health is worth
(16:41):
prioritizing.
Until next time, take care ofyourself.
This is your time.
The information shared on thispodcast is not intended to be
personal mental health advice,and listening to this podcast
does not create a therapeuticrelationship between the
listener and the therapistfeatured on this podcast.
We encourage listeners to engagewith a licensed therapist for
personalized mental healthtreatment and advice.
Today we're talking about something super practical,
but also incredibly important.
Should you use your insurance topay for therapy.
We'll go over the real pros andcons of using insurance versus
paying out of pocket.
This is one of the most commonquestions that we get from
clients, and the answer reallyisn't one size fits all.
So whether you're starting yourtherapy journey or reevaluating
(00:50):
how to continue it, let'sexplore your options together.
Let's start with this.
Therapy can be life changing,whether you're dealing with a
serious mental health condition,or navigating the everyday
stressors of life, a breakup, anew job, grief, parenting,
trauma, you name it.
You don't really need to have aformal diagnosis to benefit from
(01:12):
having a therapist who listens,validates, and helps you sort
through what you're goingthrough.
Let's be honest.
As helpful as therapy can be,it's also an investment in your
time, energy, and finances.
So it's really natural to ask,how do I make therapy affordable
without creating even morestress in my life?
(01:33):
One option is to use yourinsurance benefits, but, and
it's a big, but that doesn'tmean it's the best option for
everybody.
Before we jump into the pros andcons of using insurance for
therapy, let's pause for a quickcrash course because let's be
real.
Insurance is confusing,especially when it comes to
behavioral health.
(01:53):
So here's the simplifiedbreakdown of how insurance
typically works when it comes totherapy.
Number one, your plan typematters.
You might have A-P-P-O-H-M-O orEPO or something else entirely.
PPOs usually allow for moreflexibility.
You can see out of networkproviders and may still get
(02:14):
partial reimbursement if you'reworking with a therapist that is
not credentialed to be part oftheir network.
An HMO often requires you tostay in network and may need a
referral from your primarydoctor in order to see another
provider within that system.
If this is the case, alwayscheck specifics with your
insurance company so that youreally know what type of plan
(02:36):
you have and what the boundariesof that plan are.
Number two is to know aboutdeductibles, copays, and
co-insurance.
A deductible is the amount thatyou pay out of pocket each year
before your insurance startscovering any medical services
and the cost of those services.
(02:57):
A copay is a flat fee that youpay per visit.
For example, this may be listedon your insurance card as paying
$20 per session.
Or$35 for an urgent care visit,or$50 for a specialist visit.
If this isn't listed on yourinsurance card and you're not
sure what your copay is, or ifyou have one, that's a great
(03:17):
question to call and ask yourinsurance company.
Then we have co-insurance.
This is when you pay apercentage of the session fee
after meeting your deductible.
So even if therapy is a coveredservice in your plan.
It may not be entirely free toyou.
It really depends on where youare in your deductible cycle.
(03:38):
For example, if you have ainsurance plan with a thousand
dollars deductible and a 10%co-insurance, you will have to
pay out of pocket a thousanddollars towards your medical
care, including therapy beforeyour insurance company starts to
cover any of those costs.
Once you have paid that athousand dollars deductible out
(04:00):
of pocket, you still have to pay10% of any medical costs after
that as part of thatco-insurance element of your
plan.
So if you're not quite surewhere you land with all of that,
what your deductible is, if youhave a co-insurance percentage
or if you have a copay, theseare great questions to call and
clarify with your insurancecompany.
(04:20):
as part of the insuranceverification process at her
time, we also have a greatbiller on staff who verifies
exactly what type of plan youhave, what coverage you have,
and what is gonna be requiredfrom you out of pocket.
We will also update you on yourdeductible amounts and how far
you have to go to meet yourdeductible before your insurance
jumps in to help cover the costof those therapy sessions.
(04:44):
The third thing you wanna knowabout is in network versus out
of network.
If a provider is in network,this means that your therapist
has a contract with yourinsurance company.
If your therapist is out ofnetwork, it means that they
don't.
You might still be eligible forreimbursement after paying out
upfront, but that's where superBills come in, which we'll talk
(05:05):
about a little bit later.
So whether your ideal therapistis in network or out of network,
it means a little bit ofdifferent things for how much is
going to be required for you topay out of pocket versus how
much your insurance company willcome in to help cover the cost,
either partially, completely, ornot at all.
(05:25):
The fourth thing to know aboutis session limits and
pre-authorization.
Some insurance plans limit howmany therapy sessions you can
have per year, or they may evenrequire pre-authorization,
basically asking permission inadvance to get care.
So always ask before starting anew medical treatment such as
therapy, are there any sessionlimits or preapprovals required
(05:47):
for this behavioral healthservice?
If so, you may need to talk withyour primary care physician and
get them to give you a referralso your behavioral health
sessions are covered by yourinsurance.
lastly, another important thingto know about when it comes to
insurance is confidentiality anddocumentation to get paid, your
therapist has to submitdocumentation to your insurance,
(06:10):
including your diagnosis andsome detailed notes.
We're gonna talk a bit moreabout this in just a moment, but
this is a crucial part of theconversation, when deciding if
it's right for you to useinsurance.
Alright, now that you've got thelay of the land, let's dive into
the actual pros and cons ofusing insurance for therapy and
why it works well for somepeople and not so much for
(06:31):
others.
Ready?
Let's go./
Let's start by looking at the pros of using insurance
to pay for your mental healththerapy.
First, and maybe most obvious,it reduces your out-of-pocket
cost.
If your insurance plan includesbehavioral health coverage and
you've already met yourdeductible, your sessions may be
all or partially covered thanksto something called parity laws.
(06:55):
Insurance companies are requiredto cover mental health
conditions similarly to how theycover physical health.
Your therapist and ouradministrative staff at her time
therapy are always happy to walkyou through what your particular
plan covers and what your copayand deductible might be.
Sometimes the savings are reallysignificant, especially if
(07:15):
you're looking for weeklytherapy sessions.
Second, insurance can improveconsistency in your care.
If therapy becomes moreaffordable through insurance,
this usually means you're gonnabe able to attend sessions
weekly instead of stretchingthem out to biweekly or once a
month.
This consistent rhythm helps youmake faster progress towards
(07:37):
your goals, and it gives yourtherapist a clear picture of how
you're doing from week to week.
And third, your copays can helpmeet your deductible.
If therapy is one of manymedical expenses that you're
managing, using insurance canactually get you closer to
meeting your medical deductible,which might save you money in
the long run if you have otherprocedures or medical situations
(07:59):
that you're gonna be in later inthe year.
Now let's take a moment to talkabout the cons of using
insurance to pay for yourtherapy sessions.
I wanna be really transparenthere because these are things
people don't often realize untilthey're really deep into the
process.
So number one, and this is abiggie, insurance requires a
(08:20):
diagnosis.
So in order for your therapistto submit a claim to your
insurance company and pay foryour session, your therapist has
to assign you a mental healthdiagnosis that qualifies for
treatment under your plan.
So what if you're seekingtherapy for something
situational like a breakup or ajob change?
These are very valid reasons fortherapy, and unfortunately, they
(08:43):
may not meet the criteria for aquote unquote formal mental
health disorder.
In those cases, therapists oftenuse what we call Z codes, which
cover challenges like stress orlife transitions, but aren't
really considered a pathologicalmental health disorder.
So what's the catch?
Insurance won't pay for Z codes,even if they are the most
(09:05):
appropriate code to assign youas a diagnosis for what's
happening in your life and whatyou're coming to therapy for.
Insurance companies only coverwhat we call F codes.
These are diagnoses, whichinclude disorders like major
depressive disorder, generalizedanxiety disorder, bipolar
disorder are post-traumatic.
Stress disorder and so on.
(09:27):
The more heavy hitting kind ofmajor disorders that insurance
tends to see as meeting medicalnecessity for therapy.
Ethically, therapists can't justgive you a more serious
diagnosis just to help you getreimbursed and to be able to use
your health insurance.
So this really puts us and youin a tough position.
If your symptoms don't meetclinical thresholds, your
(09:49):
insurance won't pay.
The second issue with usinginsurance to pay for your
behavioral health sessions isthat once you receive a formal
diagnosis, if that formal F codediagnosis is appropriate for
you, it does become part of yourpermanent medical record.
That means that if you apply forjobs requiring really in-depth
background checks, high levelsecurity clearance or even
(10:13):
things like life insurance, thatinformation and that diagnosis
may be accessible to theseorganizations for these type of
life situations.
that diagnosis could potentiallyimpact your eligibility or even
your rates on things likedisability coverage or life
insurance.
In some legal situations like adivorce or a lawsuit, your
(10:34):
mental health records can evenbe subpoenaed.
And what about employees at theinsurance company?
Let's think about that.
Insurance companies can chooseto audit therapists at any time
and request whatever clinicaldocumentation they want to
evaluate if the provider ismeeting their requirements to be
in network.
This means that your treatmentplan and the progress notes
(10:56):
written by your therapist afterevery session may be viewed as
part of the insurance auditingprocess by insurance company
staff.
Third, insurance companies havethe ability to limit your care.
To some degree, depending onyour plan, your insurance
company may decide things likehow long your sessions can be,
how many sessions you're allowedto have within a year or within
(11:19):
a certain time period and whichtreatment modalities they'll
reimburse.
So for example, if you need alonger session during a crisis,
or maybe you wanna exploresomething like yoga informed
trauma therapy or EMDR, whichtypically, takes a longer
session, like a 90 minutesession, your insurance might
(11:39):
not cover those type ofmodalities and those type of
sessions even though it's whatyour provider is recommending,
it's not what your insurancecompany has deemed as payable.
A fourth issue is that it can behard to find a therapist who is
in network who is actually agood fit for you.
This is especially true forclients utilizing Medicare or
(12:00):
Medicaid benefits, and we knowfrom research and experience
that the therapeuticrelationship is the number one
predictor of whether therapyworks and whether you're gonna
get better and reach your goals.
So finding the right therapistthat is a great fit for you and
has the right training andspecialty is really tough and
it's made even harder if you'rewanting to use your insurance
(12:22):
benefits and you have to onlywork with a therapist that is
considered in network.
Many great therapists eitherdon't accept insurance or aren't
paneled yet because the processis incredibly long, arduous, and
tedious.
Handling with insurancecompanies takes several months
of paperwork and is often socomplicated that an outside
credentialing specialist isneeded to guide that process.
(12:45):
That means that the therapistyou really click with might be
considered out of networkbecause they've simply decided
not to put themselves throughthat process.
Lastly, therapists are oftenpaid much less by insurance
companies than what they wouldearn through private pay.
It doesn't matter what yourtherapist charges out of pocket
for their private therapysessions if they are paneled
(13:06):
with insurance and you'resubmitting a claim to have your
insurance company pay for yoursessions, your insurance company
is the one who decides how muchyour therapist gets paid and
reimbursed for that claim, andthat rate is often much lower
than the amount your therapistreally needs to cover in order
to pay business expenses andpersonal expenses.
This doesn't really affect youdirectly, but it also does
(13:29):
impact your therapist'ssustainability and livelihood,
and that in turn affects thekind of care that they can give
and how accessible that they areto the people who need them.
So that's a lot to consider onthe pro side and the con side of
using therapy to pay for yourbehavioral health sessions.
you may be wondering is there athird option to just paying out
(13:50):
of pocket or using insurance?
And the answer is yes.
If you're stuck in between usinginsurance and paying fully out
of pocket, there is a middleground, which is out of network
reimbursement.
this is how it works.
You pay your therapist directlyat their out of pocket rate,
usually once a month they willprovide you with a document
that's called a super bill.
(14:11):
This looks a lot like an invoicethat lists the amount of
sessions that you've had duringthat month and how much you have
paid to the therapist and to thepractice for the sessions.
You then submit that super billdocument to your insurance
company and requestreimbursement for working with
an out-of-network provider.
depending on your plan, theymight reimburse you for all or
(14:32):
for part of that out-of-pocketcost.
It's not as seamless as using anin-network provider, but it
certainly gives you moreflexibility to work with the
therapist of your choice and theone that is the right match for
you.
due to the increasing difficultyof working with insurance, both
on the client side and theprovider side, companies like
Mania have started to pop up andexist specifically for this
(14:55):
purpose to help you, the therapyclient, submit super bills to
your insurance and to getreimbursement easier.
If you feel that this thirdoption might be right for you
and you wanna learn more aboutit.
We recommend visitingmanaya.com, and that's spelled
M-E-N-T-A-Y a.com, they are oneof the biggest and most popular
(15:16):
companies right now that aredoing great work to help clients
get reimbursement easier forthose that do have that out of
network option within theirplan.
At the end of the day, usinginsurance or not is a personal
decision.
It depends on your financialsituation, your goals for
therapy, your privacy concerns,and your values.
If using insurance is the onlyway that you'll get the support
(15:39):
you need, please use it.
Your mental health is moreimportant than a perfect system,
and if paying out of pocketgives you more freedom and peace
of mind, then that's totallyvalid too.
Just remember, therapy is aninvestment in you.
You live inside your head, inyour thoughts, in your emotions,
in your past and in your future,day in and day out.
(16:00):
Choosing to prioritize yourmental health.
However you do it is neverwasted.
If you're feeling empowered bytoday's episode, be sure to
subscribe and leave us a review.
You can also follow us on socialmedia at her time to talk for
more updates and tips.
(16:20):
And if you'd like to support theshow, consider becoming a
patron.
If you're ready to take the nextstep in your mental health
journey, visit her timetherapy.com and schedule a free
consultation with one of ourtherapists.
Thank you for taking the time totalk today.
Remember, your story matters.
Your voice is powerful, and yourmental health is worth
(16:41):
prioritizing.
Until next time, take care ofyourself.
This is your time.
The information shared on thispodcast is not intended to be
personal mental health advice,and listening to this podcast
does not create a therapeuticrelationship between the
listener and the therapistfeatured on this podcast.
We encourage listeners to engagewith a licensed therapist for
personalized mental healthtreatment and advice.
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