What to consider to keep your options open for the therapist you choose
Should I only consider using insurance for mental health counseling?
We get a lot of calls at Vivify of people wanting to use their insurance benefits, and when they find out we aren’t “in-network” with their insurance carrier (we only accept Custom Design Benefits and Med Ben), they move on. That may not actually be the best (or only) option though.
We encourage people to use whatever resources they have to help them financially afford going to therapy. It’s going to be much harder to absorb what you need to from a session if you’re stressed about the cost and counting dollars every minute that ticks by. There are some important considerations though, that are important to be informed about in order to go into this investment in yourself with eyes wide open. This is admittedly not an incredibly interesting or enjoyable topic, but it’s one of those “adulting” items that everyone needs to understand. We’ve broken it down below into categories and bullets to make it easier to digest the considerations and realities of using insurance, or if you just prefer to read a summary in paragraph form, scroll on past this section for that.
How to select a counselor
In-Network Insurance:
- Choose a therapist from a list of approved providers that are contracted with your insurance carrier.
- Access this list from the equivalent of your insurance’s online “Find a provider” tool.
- Contact these providers directly to confirm suitability for your needs and/or search for more information about them online.
- Confirm when contacting that they are still in-network, as the lists are not always up to date.
Out of Network Insurance (OON):
- Many plans allow you to go “out of network” (OON). This means you can see a licensed professional that is not on the “in-network provider” list.
- Find out instantly if your plan allows this by using the Mentaya Benefits Checker on our Rates page.
- If you can go OON, you can use the options outlined in the following “Self-Pay” section to find a therapist.
Self-Pay:
- Use recommendations from people you know.
- Pick someone who has experience working with your type of issue(s) and who primarily works with your age range.
- Search online for a location that is convenient for you.
- Use filters on search platforms like Psychology Today to easily review profiles.
How to determine your actual cost
In-Network Insurance:
- No or limited coverage: Some plans offer NO or only limited coverage for outpatient mental health counseling. Verify this with your insurance directly.
- You will pay close to the self-pay rate until you meet your deductible.
- Then, your plan will either cover a % of each session, or you pay a copay.
- If you have a high deductible plan and it’s not likely you will meet your deductible this year, you may not ever get to the point where your insurance helps you cover any of the costs of therapy.
Out of Network Insurance (OON):
- Some insurance plans allow you to choose a provider that is “out of network” meaning not on their internal list of approved providers.
- If your plan allows for this, you can receive “partial reimbursement” for your sessions. You will get reimbursed a percentage of the session cost after you meet your deductible.
- Depending on your plan, this could typically be a reimbursement of anywhere from 40-90% of the session rate.
- Like In-Network, if you have a high deductible plan and it’s not likely you will meet your deductible this year, you may not ever get to the point where your insurance helps you cover any of the costs of therapy.
Self-Pay at Vivify:
Transparent and Predictable Costs: You will receive a Good Faith Estimate that clearly outlines your costs, allowing you to focus on your mental health journey without the uncertainty of insurance coverage or additional paperwork.
The process of getting it paid
In-Network Insurance:
- Present your insurance card to your therapist. Pay any required co-pay or the session rate until your deductible is met.
- Your therapy session claims may be approved or denied.
- This is typically determined by the type of diagnosis the therapist gives you and how broad your plan coverage is.
- The therapist must diagnose you with something in order for the insurance to consider covering therapy.
- If denied, you may need to advocate for yourself and submit an appeal.
Out of Network Insurance (OON):
- Pay the session fee.
- Request a “Superbill” from Vivify. (This is a modified receipt that includes a diagnosis that the therapist must give you and other info your insurance will need).
- Submit it to your insurance.
- If it is approved, the insurance carrier will mail a reimbursement check directly to you once your deductible has been met.
OR an additional easy, seamless reimbursement option at Vivify:
- Pay your session fee.
- Set up an account one time with Mentaya (takes a few minutes). Your work is done from then on!
- Mentaya will process your reimbursement claim on your behalf for a 5% fee ($5.75-$8.75 depending on your session cost) and you’ll get a reimbursement check in the mail once your deductible has been met.
- Mentaya will fight any claim denials on your behalf.
Self-Pay at Vivify:
- Enter your credit card, HSA or FSA card into our secure client portal one time.
- Your card will automatically be charged after each session.
- That’s it!
Possible privacy and confidentiality concerns
In-Network Insurance:
- The therapist must submit a diagnosis to your insurance carrier.
- Your insurance carrier may request to see your treatment plan and session notes to determine if they deem it necessary, to ensure quality of care, and that progress is being made.
Out of Network Insurance (OON):
These considerations are the same as if you were going to an in-network therapist.
Self-Pay at Vivify:
- Highest standards of privacy and confidentiality are maintained as no information is shared outside of your request.*
- Free from insurance-related documentation and restrictions associated with insurance billing.
- No formal diagnosis is required.
Treatment Options and Length
In-Network Insurance:
- Depending on the diagnosis given to you, most insurance plans will approve a certain number of sessions that they will cover (for example, 10 sessions).
- Anything beyond that will require further advocacy to get it covered, or the costs will be passed on to you.
- Some insurances will dictate which treatment methodology should be used for certain diagnoses.
- Some will only cover 45 minute sessions instead of 55 minutes.
Out of Network Insurance (OON):
These considerations are the same as if you were going to an in-network therapist.
Self-Pay at Vivify:
- Truly personalized care, tailored to your unique needs. We can explore a variety of therapeutic modalities without being limited by insurance constraints.
- Freedom to have full-length standard sessions of 55 minutes. That extra 10 minutes can make a big difference!
Availability & how quickly you can get in with someone
In-Network Insurance:
- Often in-network therapists have many months long waiting lists.
Out of Network Insurance (OON):
- Access to more choices of therapists give you a greater chance of getting in with someone quickly.
Self-Pay at Vivify:
- Vivify typically has immediate openings or at times a wait of 3-6 weeks, depending on the therapist.
Best therapeutic fit for your needs
In-Network Insurance:
- Limited choices: A therapist with the specialization you need or treatment method you’re interested in may not be on the list.
Out of Network Insurance (OON):
- More choices: You can choose any licensed therapist you want to see as long as they are willing to provide you a “Super-bill” or partner with Mentaya.
Self-Pay at Vivify:
- Total freedom: Choose whatever therapist you connect with and has experience addressing your specific needs.
Summary of what to consider when sorting out your therapy payment options
If you have insurance, it can be good to use it if your plan covers outpatient mental health counseling (some don’t!). HOWEVER, if you have a high deductible and you’re not likely to meet it–especially if it’s already later on in the year, many people prefer to just go to the therapist they want, in a location they want and pay out of pocket. Please be aware that even if you do use your insurance, you usually have to meet your deductible first (even if you are going in-network) before your insurance will begin to cover any costs. So, until that happens, you will essentially be paying the self-pay rate anyway. Also, depending on your plan and diagnosis, they may limit the amount of sessions they will approve. They will require a diagnosis to cover services, and can request access to your treatment plan and progress.
Use the free Benefits Checker at the bottom of our rates page to see if your plan allows you to see someone “out-of-network.” This is a great way to get the best of both worlds since you can go to the therapist you want, and still get some reimbursement once you’ve met your deductible. You can submit your own claim to your insurance, or for about $6-$8 Mentaya can do it for you.
Regardless of if you see someone in-network or out-of-network, if you have an HSA or FSA card, you can use that to cover any copays or the entire session cost. That is a very easy way of also using your insurance benefits indirectly.
This is a lot of information and it can be confusing and seem daunting. We are happy to talk with you to answer any questions you have. Simply schedule a free 15-minute phone consultation to talk further, and we can also verify that we have a therapist who would be a good fit for your needs.
