Understanding Your Insurance Benefits for Therapy

How mental health insurance claims work — and what you need to know before your first session

Using insurance for therapy can feel confusing and, at times, frustrating. Our goal is to make the process as transparent and smooth as possible so you can focus on your care — not billing surprises.

One of the most important things to understand is that insurance coverage is determined by your insurance company, not by your therapist or our practice. While we are happy to submit claims as a courtesy, final decisions about coverage and payment are always made by your insurance provider.

Insurance Is a Contract Between You and Your Insurance Company

Your health insurance policy is a legal agreement between you (the member) and your insurance company. Because of this, insurance companies require members to verify their own benefits and coverage details directly.

Even when we provide services that are clinically appropriate, your insurance company may decide:

• Whether a service is covered

• How much they will pay

• Whether you have met your deductible

• Whether you owe a copay or coinsurance

• Whether authorization is required

These decisions are outside of our control.

Why We Ask Clients to Call Insurance First

We ask all clients planning to use insurance to verify their mental health benefits before starting services. This protects you from unexpected costs and gives you the most accurate information about your financial responsibility. Insurance representatives can see details about your specific policy that providers cannot access.

When you call, ask these questions:

• Do I have outpatient mental health benefits?

• What is my deductible, and has it been met?

• What is my copay or coinsurance per session?

• Do I need prior authorization for therapy?

• Is there a limit on the number of sessions per year?

• Is my provider in-network for outpatient mental health?

Write down the representative’s name and a reference number for the call if they provide one.

Important: Benefit Quotes Are Not Guarantees

Even when benefits are verified, insurance companies may process claims differently over time. Coverage can change, and payments are never guaranteed until the claim is finalized.

If your insurance does not pay a claim, the balance becomes the client’s responsibility according to your insurance policy. We know this can feel stressful, and we want you to be informed upfront rather than surprised later.

How We Support You

While we cannot control insurance decisions, we do support you by:

✔ Submitting claims to your insurance company

✔ Providing receipts or superbills when needed

✔ Helping you understand billing statements

✔ Guiding you on next steps if a claim is denied

However, we are unable to call insurance companies on a client’s behalf to verify benefits or dispute coverage decisions. Insurance companies typically require the member to handle those conversations directly.

Our Focus Is Your Care

We believe financial transparency is part of ethical, supportive care. Understanding your benefits ahead of time allows therapy to stay focused where it belongs — on your growth, healing, and goals.

If you have questions about fees, billing, or using out-of-network benefits, our team is always happy to help you understand your options.