Insurance is hard to navigate, especially concerning therapy and psychiatric services. Often, these are covered differently than your typical doctors' appointments. Here's a helpful guide for understanding how you can use your insurance for therapy.
🌟 TIP: Interested in learning more about understanding your health insurance coverage and its impact on your therapy options? Check out this blog post from Grow Therapy's VP of Insurance Operations, Derek Lee.
Before you begin
You should always confirm your coverage with your insurance provider before committing to any appointments with a provider. This check ensures you're not stuck paying unexpected out-of-pocket expenses for services.
What insurance networks are accepted by Grow Therapy?
Providers on Grow Therapy currently accept a wide variety of health insurance. Coverage depends on your region. The Cost Estimate tool is the easiest way to check your eligibility. Alternatively, you can review insurance acceptance by state/region here.
If your insurance isn't accepted yet, keep an eye out. We're consistently looking to add new partners to bring affordable mental health care to everyone. In the meantime, many Grow Therapy providers offer cash pay as an option. Select "Cash" in the "Insurance" dropdown of the Find a Provider tool to review these options.
How do I contact my insurance company?
You should see a "Members Services" or "Customer Service" number on your insurance card. The number is typically on the back of your card. When speaking with your insurance, be prepared to share your ID number, name, date of birth, and social security number.
Common terms explained
Various technical terms may arise while reviewing your coverage documents or discussing your coverage with an insurance agent. Below is an explanation of the most important and common terms.
What is a copay?
A copay is a fixed cost per service. If your plan states that the mental health benefits are subject to a copay, sessions will cost the same, regardless of the CPT code(s) billed by your provider following your appointment(s).
📚 Definition: The Current Procedural Terminology (CPT®) codes offer doctors and health care professionals a uniform language for coding medical services and procedures to streamline reporting and increase accuracy and efficiency.
What is a deductible?
A deductible is the amount you pay for health care services before your health insurance begins to pay. Plans can have an individual deductible that must be met by the individual seeking care or a family deductible for all plan members to meet collectively. Deductibles typically reset every year or when starting a new plan.
⚙️ How it works: If your plan's deductible is $1,500, you'll pay 100 percent of eligible healthcare expenses until the bills total $1,500. After that, you share the cost with your plan by paying coinsurance.
What is coinsurance?
Coinsurance is your share of the costs of healthcare services. It's usually figured as a percentage of the amount the insurer allows to be charged for services. You start paying coinsurance after you've paid your plan's deductible.
Coinsurance payments continue until the end of the plan period or until you've hit the out-of-pocket maximum/limit.
⚙️ How it works: You've paid $1,500 in health care expenses and met your deductible. When you receive additional care, such as a doctor's appointment or therapy session, instead of paying all costs, you and your plan share the cost.
For example, if your plan pays 80%, the remaining 20% is your coinsurance. A $100 visit with a Grow Therapy provider would result in $80 covered by your insurance provider, with you being responsible for the remaining $20 out of pocket.
What is an out-of-pocket maximum/limit?
Your out-of-pocket maximum/limit is the most you must pay for covered services in a plan year. After you spend this amount on deductibles, copayments, and coinsurance for in-network care and services, your health plan pays 100% of the costs of covered benefits.
The out-of-pocket limit doesn't typically include the following:
Your monthly premiums (i.e., the recurring payment to your insurer for coverage)
Anything you spend for services your plan doesn't cover
Out-of-network care and services
⚙️ How it works: If your limit is $7,500 and you spend this much on services throughout the year, your insurance will cover 100% of the costs after that. No additional coinsurance payments are required.
Coverage concerns
Do you have dual coverage?
If you are covered by multiple insurance plans, please confirm with your primary insurance that they have your secondary insurance plan on file by requesting to update your Coordination of Benefits (COB). Many insurance companies will only reimburse you if you report your secondary insurance.
Also, please remember to send a copy of your secondary health insurance card to our client billing support team to avoid being charged under your primary benefits only.
Are you out of network?
If your plan is out-of-network and you do not have any out-of-network benefits, you will be billed at your provider's self-pay rate. You can request an invoice, also known as a superbill, from your provider for you to submit to your insurance for reimbursement. Self-pay visits do not count toward an insurance deductible.
If your plan does have out-of-network benefits, you will be charged along those benefit guidelines - which are often much more expensive than in-network coverage.
Session costs
How are session costs determined?
The cost of a therapy session depends on a few things, including your insurance plan, provider's qualifications, location, and session length.
Pricing is calculated based on your current plan details, and you won't be billed until after your session. If session costs do not align with your expectations, please initiate a message in your client portal to contact our client billing team.