Will Insurance Cover Mental Health Treatment?

Most people ask whether their insurance covers therapy. The more useful question is what you will pay per visit, and that number is usually knowable before you book anything. One call to your insurer and one call to the provider get you most of the way there.

If it is an emergency, insurance comes later

If someone is in immediate danger, call 911. For thoughts of suicide or an emotional crisis, call or text 988, the Suicide & Crisis Lifeline, any time. New Jersey's county psychiatric emergency screening centers evaluate people in a psychiatric emergency whether or not they have insurance. In Middlesex County that is Rutgers University Behavioral Health Care at 732-235-5700, which serves adults. For a child or teen, call PerformCare first at 1-877-652-7624, 24/7. In Camden County it is Oaks Integrated Care at 856-428-4357. Our crisis page has more.

What parity does and does not do

Under federal "parity" laws, most health plans that cover mental health and substance use care must do so on terms comparable to physical health care. In practice, your plan generally cannot apply copays, deductibles, or visit limits to mental health care that are more restrictive than those it applies to comparable medical care.

That does not make care free, and parity does not apply identically to every plan. What it gives you is a benchmark. If your in-network therapy copay or coinsurance is higher than what your plan charges for most in-network medical office visits, ask the insurer to explain it. Federal parity rules compare therapy with medical office visits as a group, not with one type of doctor.

The terms that decide your cost

You will hear five terms on the call:

• Premium. What you pay each month to have the plan, whether or not you use care.
• Deductible. The amount you pay out of pocket each year before insurance starts sharing costs. Ask whether it applies to therapy visits on your plan.
• Copay. A flat fee per visit, for example $30 for a therapy session.
• Coinsurance. A percentage of the cost you pay, for example 20%, instead of a flat fee.
• In-network and out-of-network. In-network providers have agreed to your insurer's rates, so you pay far less. Out-of-network care costs more, and sometimes is not covered at all.

Of the five, network status is the one to confirm with both the insurer and the provider.

The call to your insurer

Call the member services number on the back of your insurance card and ask:

1. "Does my plan cover outpatient mental health visits?"
2. "Do I have a deductible for mental health care, and if so, have I met it?"
3. "What is my copay or coinsurance for an in-network therapy session?"
4. "How do I find in-network mental health providers near me?"
5. If you are considering something more intensive: "Is IOP or PHP covered, and does it need prior authorization?"

Write down the date, who you spoke with, and a reference number if they give one. Coverage details are occasionally quoted incorrectly, and a record helps if a bill looks wrong later.

If your coverage comes through an employer, our online therapy guide explains one more question to ask if you plan to use telehealth: whether the plan is self-funded.

Then call the provider and ask two things: whether it is in network with your specific plan, and whether it is accepting new patients.

Prior authorization

For higher levels of care, such as intensive outpatient or residential treatment, insurers often require prior authorization: approval, in advance, that the care is medically necessary. Ask the program whether it requests the authorization or whether you need to, and confirm it has been approved before treatment begins.

If you have no insurance, or coverage falls short

You still have options:

• Sliding-scale therapists set fees based on your income.
• FQHCs and certified community behavioral health clinics must serve patients regardless of ability to pay, and many other community mental health agencies in Middlesex and Camden counties set fees by income. In Camden, Project H.O.P.E. (856-968-2320) is a federally qualified health center that provides behavioral health services and serves patients regardless of ability to pay.
• Training clinics at universities offer lower-cost sessions with supervised graduate clinicians. In Middlesex, the Rutgers Center for Psychological Services (GSAPP) in Piscataway (848-445-6111) is one. Some GSAPP clinics offer low-cost services based on household income and ability to pay, so ask when you call.
• NJ FamilyCare, New Jersey's Medicaid program, covers behavioral health for those who qualify, and you can apply any time of year. See what NJ FamilyCare covers and how to check eligibility.

Our guide to getting therapy in NJ without insurance goes through each of these, and the local resources page lists the clinics we could verify in both counties.