Understanding Insurance Coverage for Therapy
Therapy is an investment in your mental health, but navigating insurance can sometimes feel overwhelming. At Empowerment Within, we want to help you make informed decisions by providing clarity on how insurance works, what it covers, and why some clients choose to opt out of using it for their therapy sessions.
What Does Insurance Cover?
Insurance companies typically only cover medically necessary services, which means:
- They require a diagnosis from the DSM-5, which stays on your permanent record.
- Preventative or ongoing maintenance therapy, such as exploring personal growth or working on long-term emotional resilience, is often not covered.
- This diagnosis can impact other areas of your life, such as eligibility for life insurance, marketplace health insurance, or being flagged in your medical records shared with other providers.
It’s important to understand these implications so you can decide what’s best for you.
What Information Does Insurance Require?
To process claims, insurance companies require detailed documentation, including:
- Progress notes that track your sessions.
- Any additional assessments they determine are necessary to justify coverage.
Insurance providers also have the right to review your services and can retroactively decide that services were not medically necessary, even up to seven years after your sessions. This level of oversight can feel invasive and may limit your therapy experience.
What If I Choose to Pay Out-Of-Pocket?
While insurance can make therapy more affordable, there are significant benefits to paying privately for your mental health care:
Privacy and Confidentiality
Your records stay with us. Outside of mandated reporting requirements (for self-harm, harm to others, or child abuse/neglect), no one else has access to your information.
Flexibility in Services
Without insurance restrictions, you can choose the frequency and focus of your sessions. Many growth-oriented or preventative topics may not be covered by insurance, but they remain integral to your progress.
Session Length
Insurance typically limits coverage to 60-minute sessions. For approaches like 90-minute Brainspotting sessions, which can be more impactful, private pay allows you the flexibility to schedule what works best for you.
Still Have Insurance Questions?
Choosing whether to use insurance for therapy is a deeply personal decision. Our team is here to answer your questions, provide clarity, and help you make the choice that best supports your needs and goals. We’re happy to help you navigate the details and explore your options. Reach out to our team to discuss your situation and how we can work together to create a plan that works for you.
