Does Insurance Cover Therapy? UHC, Aetna, and Horizon Coverage Explained

By Chanill Medina, LMFT

Cost is one of the most common reasons people put off starting therapy, even when they know they want it. The good news is that for individual therapy at Generational Wellness Center, three of the largest insurance carriers in New Jersey and New York can cover all or part of your sessions. This article walks through what insurance covers, what it does not, and how to find out what you would actually pay before you book.

Insurance We Accept

I am in-network with three carriers for individual therapy sessions:

United Healthcare
Aetna
Horizon (including Horizon Blue Cross Blue Shield of New Jersey)

If you have one of these plans, your individual sessions can be billed directly to insurance. You pay only your copay, coinsurance, or whatever your plan requires after your deductible has been met.

What Insurance Does Not Cover Here

Couples therapy and family therapy at Generational Wellness Center are private pay only. This is not a quirk of my practice. It is how most carriers handle relational work. Insurance typically only pays for a single identified patient with a mental health diagnosis. Couples and family work focuses on the relationship itself, which usually does not meet the criteria insurance uses to authorize coverage.

For that reason, couples sessions are $225 and family sessions are $225, paid at the time of service.

How to Find Out What You Will Pay

The best way to know your real out-of-pocket cost is to call the member services number on the back of your insurance card before your first session. Here is exactly what to ask:

Do I have outpatient mental health benefits on my plan?
What is my copay for an in-network telehealth therapy session, CPT code 90837?
Do I have a deductible I need to meet first? If yes, how much of it have I met this year?
Is there a session limit per year?
Do I need pre-authorization?

Most plans cover therapy with no pre-authorization required. Most have either a flat copay (usually $15 to $40 per session) or a percentage of the session fee after the deductible is met.

What If My Insurance Is Not on Your List

If you have a different insurance carrier, you may still have what is called out-of-network coverage. Many PPO plans reimburse a portion of the session fee even when your provider is not in-network. In that case, you would pay me directly for each session, and I would provide what is called a superbill on request. You submit the superbill to your insurance, and they reimburse you according to your out-of-network benefits.

To find out if this applies to you, ask your insurance member services line:

Do I have out-of-network mental health benefits?
What is my out-of-network deductible, and how much have I met?
What percentage of an out-of-network therapy session do you reimburse?

What Counts as a Therapy Session for Billing

For insurance purposes, my standard individual session is billed as CPT code 90837, which is a 60-minute individual psychotherapy session via telehealth. The diagnosis on the claim is whatever clinical condition we work on together, such as generalized anxiety, major depressive disorder, post-traumatic stress, or adjustment disorder. I will discuss your diagnosis with you openly during our work. It does not get added to your file in secret.

Privacy and Diagnoses on Your Record

One thing worth knowing: when you use insurance, your insurance company has a record that you received mental health treatment and what your diagnosis is. For most people this is not a concern, but for some careers (certain federal clearances, life insurance underwriting in some cases, certain custody disputes) it can occasionally matter. If you would prefer to keep no diagnosis on file with any insurance company, private pay is always an option for individual sessions too.

Bottom Line

If you have United Healthcare, Aetna, or Horizon and you live in New Jersey or New York, individual therapy with me may cost you only your copay. Couples and family sessions are $225 regardless of insurance. And if your insurance is not on the list but you have a PPO with out-of-network benefits, you may still be reimbursed for part of each session.

The clearest path is a free 15-minute consultation, where I can answer your specific cost questions before you commit to anything.

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