Navigating Coverage and Reimbursement for Therapy

Let’s be real -insurance is confusing, and trying to figure out if your therapy sessions will be covered while you’re in a time of need can be overwhelming! We’ve created this short guide to demystify what each option means for mental health coverage in a clear and digestible way.

Whether you have No Benefits, HSA / FSA, PPO / POS, or HMO You deserve Access to mental healthcare, and you have options.

If you’re deciding which type of plan is best for you, read through the whole post. If you’ve already know what type of benefits you have, find your plan type and read that section to understand what it means for your therapy sessions.

No benefits

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Can this help with the cost of therapy?

If affordability is an important part of accessing mental health you do have options. Sliding scale and low fee therapy is available at a range of prices.

Can this help pay for therapy with CMP?

CMP is a sliding scale organization. Our therapists offer therapy at a range of prices that they set themselves. Our fees are usually lower than other therapists in private practice but are not often as low as a "low-fee" clinic.

What's a great thing about this option?

The accessibility regardless of your budget! Generally, earlier career therapists offer lower fees but earlier career doesn't necessarily mean less effective when it comes to therapy. There are some amazing new therapists and you may find an awesome fit no matter how long someone has been practicing. Ask our intake team about clinicians offering sliding scale. There are also many options for lower fee therapy in the Bay Area. Accessible mental health is so important!

What's a drawback of this route/what should I know?

While early-career does not correlate directly with how good the therapy is, you will have fewer options than if fee is limiting. The more flexibility you have around fee the more therapists you will be able to choose from.

I'm going this route. Tell me more!

Some clinics base fee on household income and some base fee on what you feel is affordable for you. If a therapist or clinic is not a good fit for you because of cost they may be able to offer referrals to more affordable options.

What should I ask to be informed about details?

You may want to ask: How does this provider structure fee-setting? What will your fee be? What level of training do the therapists(s) have? Are they able to meet with you once a week/is that something they ask of you? Is there anything else they think you should know?

HSA or FSA

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Can this help with the cost of therapy?

Yes. You can use these funds to pay for therapy directly if you have a debit card attached to the account. Generally these funds are part of your pay but the plans allow you to use them for healthcare costs pre-tax.

Can this help pay for therapy with CMP?

Yes!

What's a great thing about this option?

These types of benefits usually offer a lot of flexibility on choosing who you would like to work with. It's your money so you get to make more choices!

What's a drawback of this route/what should I know?

There is usually a cap on the amount of funds in these accounts, and it's your money.

I'm going this route. Tell me more!

Start thinking about what you would like to find in a therapist. Is there a specialty you hope they have? Something about them that feels important to you? Location? Type of therapy? Is a lower fee also important?

What should I ask to be informed about details?

You may want to know how much money is in your account. It could be deposited annually, quarterly, or based on hours worked. You may also want to verify how the payment process works if you don't have a debit card tied to the account funds.

PPO or POS

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Can this help with the cost of therapy?

Yes. PPO or POS plans usually offer benefits that help pay for therapy with a therapist of your choice. They also sometimes offer in-network coverage -to explore this route see details of "HMO".

Can this help pay for therapy with CMP?

Yes! How much will depend on your individual coverage and your insurance company should be able to help you understand what your out of pocket costs will be.

What's a great thing about this option?

The flexibility! And possibly the lower final cost to you depending on your plan.

What's a drawback of this route/what should I know?

While you can choose almost any therapist you want you will be responsible for payment up front. Most therapists will be considered "out of network providers" and can give you receipts for session you have had and paid for and you can submit receipts to your insurance company for them to reimburse part of your cost back to you.

I'm going this route. Tell me more!

Start thinking about what you would like to find in a therapist. Is there a specialty you hope they have? Something about them that feels important to you? Location? Type of therapy? Is a lower fee also important?

What should I ask to be informed about details?

You may want to ask: How does this provider structure fee? What will your out of pocket cost be? Do you need to pay for services fully until you reach a deductible first (if so what is it)? Is there an out of pocket maximum? Is there anything else they think you should know?

HMO

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Can this help with the cost of therapy?

Yes. HMOs usually restrict you to in-network providers.

Can this help pay for therapy with CMP?

Unfortunately not. Our therapists are not in-network with any insurers. A benefit of this can be that they generally have fewer clients than in network therapists and can devote more attention to those they work with.

What's a great thing about this option?

The price! HMOs can offer the most affordable therapy from fully licensed (very experienced) therapists in a private practice setting.

What's a drawback of this route/what should I know?

In-network coverage varies greatly. Therapy is most effective when engaged with regularly and consistently. When you need support, weekly meetings can be important and some insurance companies don't offer this automatically. Finding an in-network provider who is accepting new patients may take some time and being able to self-advocate might be important.

I'm going this route. Tell me more!

If using insurance to help pay for therapy is important you can get a list of therapists who work with your insurance provider. These therapists are "in-network" and you will be responsible for a copay (less than the total cost). The insurance company will then pay the remainder to the therapist directly.

What should I ask to be informed about details?

You may want to ask: How does this provider structure fee? What will your out of pocket cost be? Do you need to pay for services fully until you reach a deductible first (if so what is it)? What level of training do the therapists(s) have? Are they able to offer and cover meetings at least once a week if that is what you and/or your therapist feel will be helpful? Is there an out of pocket maximum? Is there anything else they think you should know?

If you have specific questions about your plan & coverage, It’s always a good idea to contact your Insurance Provider.

If you have questions about the cost of Therapy at The Center for Mindful Psychotherapy feel free to contact our intake team or reach out to a therapist of your choice Directly.