Confused about how to access mental health care? Learn more about how to find a plan that covers out-of-network therapy!
Have you been putting off therapy because you’re struggling to find someone in-network? Or you do have out-of-network coverage, but it only covers a small percentage of your payment? Maybe you are already paying for therapy out-of-pocket, but want to reduce your expenses.
You may not have been thinking about attending therapy when you chose your insurance plan, or understood the details of what would be covered when you signed up. But if you’re finding your options are limited now, you’re not alone. Most private therapists in California (including Stella Nova) do not accept insurance directly, for a variety of reasons. But insurance plans do exist that can cover a large portion of your out-of-pocket therapy expenses, if you know what you’re looking for.
Find Better Coverage for Therapy in California During Open Enrollment
Now through the end of January, it’s open enrollment in California. That means that you have the opportunity to change out your current plan for one that provides better coverage for therapy services.
If you would like to work with an out-of-network therapist, you will most likely want to choose a PPO plan. These types of plans will allow you to work with any licensed therapist. In most cases, you’ll have to pay the therapist their full rate up front, and then submit a superbill (a special type of invoice) for reimbursement from the insurance company.
You can apply for insurance plans online via the Covered California website, through a participating broker, or speak with an agent over the phone. You don’t have to meet any particular income requirements to use this service, but depending on your household income, you may qualify for a discount on your insurance plan. When I first signed up for my plan, there was a long wait to speak with the agent, so be prepared. But she was phenomenally helpful and kind! I had a fantastic experience, although your mileage may of course vary.
What Should I Look For In a Plan?
When you’re comparing plans, you’ll of course want to verify that there is out-of-network coverage for therapy, and what percentage of your fee they will cover. This can vary quite a bit from plan to plan. You may also want to consider whether a lower- or no-deductible plan, despite a higher monthly premium, will save you money by allowing your coverage to kick in right away.
Some other questions to consider asking before choosing your plan:
- Are telehealth sessions covered at the same rate as in-person sessions?
- Will I need a referral from my primary care provider or a pre-authorization to access therapy?
- Are there any limitations on my coverage, such as a maximum dollar amount or number of sessions?
I’m Actually Not Sure if I Out-Of-Network Benefits Or Not?
If you haven’t tried to access therapy before (or even if you have!), you may not be sure what coverage you already have. I have seen a number of clients who haven’t even attempted to use their out-of-network benefits because the process of tracking down that information felt overwhelming.
One way to get a quick estimate is to use Mentaya’s benefit checker, which we use here at Stella Nova to help give new clients a snapshot of their coverage. If you’re curious, you can check your own benefits here for free. This is a HIPAA secure service we pay for to help prospective clients figure out their coverage — we’re not getting any kickbacks for promoting them. If you do have benefits, they can also take over the claim submission process for a small fee, saving you the headache of having to deal with your insurance company. But it’s totally possible to DIY if you’d rather get every penny of that reimbursement!
We do advise caution when using any online benefits checker, as they’re only able to give you an estimate based on the “allowed amount”. It is still possible your insurance company could have a cap on coverage that you’ll only know by calling them to ask. For a more detailed explanation of your benefits, call your insurance company using the number on the back of your insurance card.
Therapy’s a big investment, but having your insurance company reimburse a portion of your expenses can make it much more accessible. If you are looking for a therapist in California, we’re happy to answer any questions you may have about using your out-of-network benefits! Feel free to reach out via email or schedule a free, 20-minute consultation with our intake coordinator to learn more.
About The Author
Dr. Maya Borgueta is a licensed psychologist specializing in women’s mental health, with a focus on serving women of color the LGBTQ+ community. She has over 10 years of experience providing therapy to California residents. Maya’s areas of expertise include work stress and workplace trauma, anxiety, self-compassion and immigrant mental health. She is the owner of Stella Nova Psychology, a San Francisco based practice offering therapy to clients all over California.
Online Therapy for California Residents
Need some extra support this holiday season? Don’t wait until the new year to start therapy! Stella Nova offers online therapy for adults and couples online throughout California, and in-person in San Francisco. Our team has specialties in a variety of common mental health concerns, including depression, anxiety and stress, burnout, trauma, and more.
Sign up for a free, 20-minute consultation to get matched with a great-fit therapist today!