Health Insurance and FAQs
Health Insurance Information for Therapy and Psychiatry services at CMHS
An understanding of insurance benefits should not present a barrier when seeking mental health assistance. CMHS is dedicated to ensuring the process is easy and stress-free.
Our team will check on the benefits you have with your insurance plan and explain any costs you will be responsible for. Prior to starting therapy, you will receive an estimate so you are not surprised by an unexpected cost.
In most health insurance systems, behavioral health benefits are standard, and benefits are also offered when therapy or psychiatry services are needed.
Following is a list of the insurance companies which are accepted by CMHS.
Participating Health Plans We Accept
This list reflects current CMHS participation and contract status. However, individual clinician participation may vary. To receive the highest level of benefits, please check your health plan by calling the number on the back of your insurance card to verify that your specific provider is in network. Insurance company websites may also be out of date.
If you don’t see your insurance plan listed, call our office; we’re happy to check.
Does Health Insurance Cover Therapy?
Yes, most health insurance plans will cover the costs associated with therapy and psychiatry. This means that your therapist gives you a diagnosis and a treatment plan, which meets your insurer’s guidelines for mental-health care.
Having insurance does not mean that it is free; there might be copays, deductibles, or coinsurance, depending on your plan.
Coverage will vary depending on your insurance carrier, type of plan, and its network status, but our team will explain your benefits to you step by step.
What is the Difference Between an HMO and a PPO?
HMO stands for Health Maintenance Organization.
An HMO provides care through a specific, contracted network of providers. These plans generally offer lower monthly premiums but require members to stay in-network.
Some HMO plans require you to choose a primary care physician (PCP) who coordinates your care. Your PCP may need to provide a referral before you see a therapist or other mental-health specialist. If you see an out-of-network provider under an HMO, the plan may not cover any portion of the service.
PPO stands for Preferred Provider Organization.
A PPO also uses a network of providers, but it offers more flexibility than an HMO. Patients can see in-network or out-of-network providers, often without needing a referral.
PPOs usually have:
- Higher monthly premiums
- Higher out-of-pocket costs
- More freedom of choice in providers
With most PPO plans, referrals from a PCP are not required for mental-health services, making it easier to initiate therapy.
What If I Don’t Have Health Insurance?
If you’re putting off therapy because you don’t have insurance, you’re not alone, and you still have options.
CMHS offers:
- Low self-pay rates
- Guidance about using HSA/FSA funds
- Assistance in identifying the most inexpensive alternatives
We will work with you so that therapy is accessible to you as much as possible.
Mental Health Services at CMHS
Our team at CMHS support people of all ages with a wide array of emotional and mental-health needs, including but not limited to anxiety, depression, trauma, stress, and relationship challenges.
Most insurance companies, including Medicaid and major commercial carriers, cover therapy and psychiatry services. If you have any questions about your plan or would like further help in understanding your benefits, don’t hesitate to ask. Our team is here to help.
Please don’t hesitate to contact our office today to discuss coverage, verify your benefits, or set up an appointment. We’re here to help you start your therapy or psychiatry services with confidence and clarity.
Understanding Common Insurance Terms
Copay
A copay is the fixed amount you pay at each session. For instance, your plan may require a payment of $20 or $30 per visit. Plans that have lower premiums generally have higher copays.
Deductible
Your deductible is the amount you must pay out-of-pocket before your insurance begins contributing. If your deductible is high, you may pay full session fees until it’s met.
Coinsurance
After your deductible is met, you may share the cost of sessions with your insurance company (e.g., you pay 20%, the plan pays 80%).
Out-of-Pocket Costs
This includes all expenses not covered by insurance, such as deductibles, coinsurance, and any fees for out-of-network services.
HSA / FSA Accounts
Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA) can be used to pay for therapy sessions using pre-tax funds. Medical Necessity Insurance plans often require that therapy be “medically necessary” for coverage. This simply means your therapist documents symptoms and a diagnosis that your plan recognizes as eligible for treatment benefits.
