Insurance

Yes, health insurance covers mental health services depending on your specific plan. Benefit amounts and limits differ depending on your state and the plan you select.

Keep in mind that just because a plan covers mental health testing services and treatments doesn’t guarantee that all services are covered. For example, stress induced by life changes such as a divorce or financial issues may not be covered. However, according to the Mental Health Parity and Addiction Equity Act (MHPAEA), enacted in 1996, stress as a symptom of a medical illness such as depression should be covered.¹

Insurers must provide equitable coverage for mental health issues under the Affordable Care Act, the MHPAEA, and other federal laws. This means companies must treat mental health conditions the same way they treat physical health conditions. They can’t exclude them from coverage, and they can’t charge higher copays.²

According to Kaiser Family Foundation (KFF), between September 29 and October 11, 2021, 34.6% of individuals in Tennessee reported anxiety or depression symptoms, compared to 31.6% of adults in the United States.³

In addition, the 2021 State of Mental Health in America report cited that Tennessee climbed eleven ranks to 28th place in responding to its populations’ mental health needs. The annual ranking of all 50 states and the District of Columbia looks at data trends in several categories such as mental illness, substance use disorder, suicidal thoughts, and access to care for both adults and adolescents.⁴

Athena Care owns multiple mental health services clinics in TN and is in-network with most major insurance plans. Filling out our free and confidential online insurance verification form is the easiest and quickest method to determine your mental health insurance coverage.

Let our highly experienced, expert care coordinators handle the difficulties of contacting your insurance carrier for more information about mental health insurance. After completing the form, a care coordinator will review your policy and thoroughly explain your options. Rest assured, all submitted or discussed information is kept confidential.

Insurance for mental health may cover services including but not limited to:

• ADHD testing & treatment
• Behavioral health therapy treatment
• Cognitive behavioral therapy (CBT)
• Dialectical behavior therapy (DBT)
• Eye Movement Desensitization and Reprocessing (EMDR)
• Psychiatric hospitalization

Your mental health insurance coverage can cover the following mental health conditions, including but not limited to:

• ADHD
• Anxiety
• Bipolar disorder
• Depression
• Obsessive-compulsive disorder
• Personality disorder
• Post-traumatic stress disorder (PTSD)
• Schizophrenia
• Substance use disorder

• Aetna
• Ambetter TN
• Blue Cross Blue Shield
• Carelon
• Cigna
• Evernorth
• Medicare
• Multiplan
• Optum
• PHCS
• TRICARE
• United Healthcare
• Vanderbilt

• PPO: Preferred Provider Organization (PPO) is a health plan in which medical providers enter into contracts to form a network of participating providers, including mental health specialists. You’ll pay more for out-of-network care.

• HMO: Health Maintenance Organization (HMO) is a health insurance plan that often only covers care provided by doctors who work for or contract with the HMO. Aside from an emergency, it usually does not cover out-of-network care.

• EPO: Exclusive Provider Organization (EPO) is a managed care plan that only pays for treatments provided by doctors, specialists, and hospitals in the plan’s network, except in the case of an emergency.

• Deductible: The amount a policyholder must pay out of pocket before an insurance company will cover any expenditures.

• Out of Pocket Cost: Medical expenses that aren’t covered by insurance.

• In-Network: Providers or healthcare facilities that are part of a health plan’s network with whom it has negotiated a discount.

• Out-of-network: This refers to a health insurance plan that does not have a contract with a doctor or healthcare provider, occasionally leading to a cost increase for services rendered.

• Copay: A copay, sometimes known as a copayment, is a set amount paid by a patient to the service provider before receiving the service.

• Coinsurance: After you’ve paid your deductible, the portion of the cost of a covered healthcare service that you pay (20%, for example).

Yes, many insurance plans cover mental health medications and prescriptions. The specifics of your coverage are dependent upon your plan’s benefits. Additionally, therapy covered by insurance may include medication therapy management (MTM).

Yes, many plans include online therapy insurance. Online therapy covered by insurance became increasingly common during the pandemic. However, states have varying online therapy coverage rules and standards. Not every state requires insurance to cover the cost of these treatments at the same rate as in-person therapy.⁵

Medicaid covers millions of people in the United States, including low-income adults, children, pregnant women, the elderly, and persons with disabilities. States are in charge of administering Medicaid, mandated by the federal government.

Tennessee’s Medicaid program is known as TennCare. It primarily serves low-income pregnant women, parents or guardians of minor children, children, and the elderly or disabled.⁶

Medicare is a government-run national health insurance program that began in 1965 under the Social Security Administration. Today, the Centers for Medicare and Medicaid Services administer its four parts (A-D).

All of the above provide mental health insurance coverage.⁷ However, your plan’s benefits determine the specifics of this coverage. Medicaid, for example, is the largest payer of mental health services in the United States, increasingly playing a more significant role in the funding of substance use disorder treatment.⁸

Health insurance providers typically won’t cover services and procedures that are not deemed medically necessary. A medical necessity means a decision by your health plan provider that your test, treatment, or procedure is needed to maintain or restore your health or address a diagnosed medical problem.⁹

Elective or cosmetic procedures, beauty treatments, fertility treatments, off-label medicine use, some alternative medicine treatments like acupuncture and brand-new technology are usually not covered by health insurance providers.¹⁰ In addition, some counseling treatments, like couples therapy, are rarely covered by insurance.

Mental health insurance coverage costs can vary depending on your specific health plan and personalized needs. The following are average costs, though they may vary by location and other variables and may not reflect the actual cost of treatment or what you may actually pay.

For example, In the United States, the typical cost of psychotherapy ranges from $100 to $200¹¹ a session, dependent upon the location and the length of the session. In addition, you’ll most likely have a copay that can range from a few dollars to $50 or more a session with health insurance.

Cognitive Behavioral Therapy (CBT) sessions are typically 45+ minutes long and cost between $100 and $200 per session, while Dialectical Behavior Therapy (DBT) usually consists of a weekly individual therapy session, a weekly group therapy session, and weekly telephone conversations. DBT costs vary depending on the duration and type of services rendered.

Additional factors, like whether the therapist is in-network or out-of-network, can influence this out-of-pocket cost.

Even with insurance, you will normally have to pay some or all of your medical expenditures until your total medical expenses reach the deductible. Then, depending on your plan, you may be required to pay a copay or coinsurance for each service or treatment.

Some therapists will work with patients on a sliding scale for those who do not present insurance. If you find a therapist who offers this type of payment plan, they will most likely base the cost of your sessions on your income. This sliding scale can also vary from therapist to therapist.

Treatment does not require a formal diagnosis. You should never put off getting critical mental health attention because you don’t have coverage or don’t understand it.

These alternatives¹² may help you find and afford mental health services if you don’t already have a healthcare plan that offers mental health insurance coverage:

• Local social services: Free or low-cost mental health services may be available at student health centers or federally designated health centers such as community-based facilities sponsored by the federal government.

• University hospitals: Patients can often access interns and residents at university hospitals on a sliding fee basis. This is usually significantly less expensive than private practice mental health specialists.

• Non-profit options: Not-for-profit groups match inexpensive mental health treatments to middle and lower-income persons and their families.

• Employee Assistance Programs (EAP): Some employers pay for these benefits, so employees have free access to them. The employee handbook or human resources department can provide additional information on EAP benefits.

• Disability Benefits: If you have a persistent or severe mental condition that prevents you from working, you may be eligible for disability benefits. These advantages do not always include medical coverage. They may, however, be able to assist you in obtaining Medicare coverage, including mental health benefits, even if you are not 65 years old.

1. Grey, Gina-Roberts. “Are Mental Health Services and Therapy Covered by Health Insurance?” GoodRx, Inc., 2022, https://www.goodrx.com/insurance/health-insurance/mental-health-insurance-how-to-get-help
2. “Does Insurance Cover Couples Therapy?” GoodTherapy LLC, 2022, https://www.goodtherapy.org/blog/faq/does-insurance-cover-couples-therapy
3. “Mental Health in Tennessee.” Kaiser Family Foundation, 2022, https://www.kff.org/statedata/mental-health-and-substance-use-state-fact-sheets/tennessee/
4. “National Ranking Highlights Tennessee’s Advancement in Serving Mental Health Needs of Citizens.” Tn.gov, 2021, https://www.tn.gov/behavioral-health/news/2020/11/13/national-ranking-highlights-tennessee-s-advancement-in-serving-mental-health-needs-of-citizens.html
5. Calkins, Hannah. “Online Therapy is Here to Stay.” American Psychological Association, 2022, https://www.apa.org/monitor/2021/01/trends-online-therapy
6. “TennCare Medicaid.” https://www.tn.gov/tenncare/members-applicants/eligibility/tenncare-medicaid.html
7. Rossheim, John. “Does Medicare Cover Mental Health Services?” NerdWallet, Inc., 2022, https://www.nerdwallet.com/article/insurance/medicare/does-medicare-cover-mental-health-services
8. “Behavioral Health Services.” https://www.medicaid.gov/medicaid/benefits/behavioral-health-services/index.html
9. Bihari, Michael MD. “The Definition of Medical Necessity in Health Insurance.” Fact checked by Marley Hall, Dotdash Media Inc., 2022, https://www.verywellhealth.com/medical-necessity-1738748
10. Zucchi, Kristina. “What Does Health Insurance Not Cover?” Fact-checked by Kirsten Rohrs Schmitt, 2022, https://www.investopedia.com/articles/insurance/09/services-health-insurers-do-not-cover.asp
11. Lauretta, Ashley. “How Much Does Therapy Cost?” edited by Alena Hall, Forbes Health, 2021, https://www.forbes.com/health/mind/how-much-does-therapy-cost/
12. Roberts-Grey, Gina. “How to Access Therapy and Other Mental Health Services If You Don’t Have Insurance.” GoodRx, Inc., 2022, https://www.goodrx.com/well-being/healthy-mind/therapy-mental-health-services-without-insurance