How much does therapy cost with unitedhealthcare

Deborah C. Escalante

United Healthcare

United is one of the largest health insurance companies in the world (and the biggest by revenue). United coverage includes mental health, behavioral health, and therapy services. This guide outlines the coverage that United typically provides for therapy services.

Does United Behavioral Health cover therapy?

Yes, nearly all United Behavioral Health plans cover therapy for mental and behavioral health conditions.

Health insurances offered through the health insurance Marketplace or through small employers are required by the Affordable Care Act to cover mental health services. While not required by federal law, the vast majority of large employers also cover mental health services.

While rare, your United plan may not cover therapy services if:

  • You work for a large employer that does not include mental health benefits in its insurance coverage.
  • Your health insurance plan was created before 2014, when the ACA’s requirement that health insurance plans cover mental health services was enacted.There are other situations in which your United plan may not cover the specific type of therapy service you are seeking, or where your coverage may not apply until you spend a certain amount on medical services first. Learn more about these cases below.

How do I check if my United plan covers therapy?

To check whether your United plan covers therapy, look for the “Outpatient Mental Health” line item on your Summary of Benefits.

Therapy is considered a type of outpatient mental health service. You can find your Summary of Benefits by logging into your United Member Services portal (called “myUnited”), calling member services, or checking your employer’s benefits portal.

Here is an example of what your United Summary of Benefits may look like, and where to find the Outpatient Mental Health line item:

If the Outpatient Mental Health line item indicates that these services are not covered, then your health insurance plan does not cover therapy services.

If you cannot find coverage information for Outpatient Mental Health, you can contact United for assistance. If you receive health insurance through your employer, reach out to your employer’s human resources department.

While your United plan likely covers therapy, the extent of coverage and requirements for coverage depend on your particular plan. Read on to learn more.

How much does therapy cost with an United Behavioral Health plan?

The cost of therapy sessions with United depends on your plan’s coverage: in the best case scenario, your therapy sessions may be fully covered, meaning you don’t pay anything at the time of session; most likely, the cost ranges from $15 to $50 per session. In the worst case scenario, you need to pay the full fee that the therapist charges at the time of the session, which generally ranges from $80 – $200 per session. Find the scenario that applies to you below:

If you choose a therapist who is in-network with United, your therapy sessions likely cost between $15 – $50 per session, after you meet your deductible. The $15 – $50 amount is your copay, or the fixed amount that you owe at each therapy visit. The deductible is the total amount you need to spend in medical costs in any given year before your health insurance begins to cover the cost of services. Here are examples you may see on your Summary of Benefits under the “In-network Outpatient Mental Health” category and what they mean:

  • $15 copay, after $5,000 deductible → After you spend $5,000 in medical costs this year, your therapy sessions will cost $15 per session.
  • $15 copay, after $1,000 deductible → After you spend $1,000 in medical costs this year, your therapy sessions will cost $15 per session.
  • $15 copay, deductible does not apply → Your therapy sessions will cost $15 per session regardless of your deductible amount (ie. even if this is your first medical visit of the year, you will only pay $15 at the time of your therapy session).
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If you choose a therapist who is not in-network with United and you have a United PPO Plan, your therapy session will likely cost between $50 – $100 per session, or 20% – 50% of the full amount that your therapist charges per session. This percentage is called a coinsurance: you pay the therapist’s full fee at the time of the session, send a claim to your health insurance company, and receive a check or direct deposit for the remaining percentage that your plan covers. PPO plans typically only cover out-of-network services after you meet your deductible. Here are examples you may see on your Summary of Benefits under the “Out-of-Network Outpatient Mental Health” category and what they mean:

  • 20% coinsurance, after $5,000 deductible, therapist charges $100/session → After you spend $5,000 in medical costs this year, your plan will reimburse you $80 of your therapy session fee; your effective therapy cost is $20/session.
  • 20% coinsurance, after $1,000 deductible, therapist charges $150/session → After you spend $1,000 in medical costs this year, your plan will reimburse you $120 of your therapy fee each time you submit a claim; your effective therapy cost is $24/session.

If you choose a therapist who is not in-network with United and you have a United HMO or EPO Plan, your plan will likely not reimburse you for sessions with a therapist who is not in-network with United. You would owe the therapist’s full fee at the time of session and not receive reimbursement from your plan. If cost is a barrier to seeking therapy, you can look for a therapist who offers a sliding scale, or lower session fees based on financial need.

What types of therapy does United cover?

The modalities that United Behavioral Health covers may include, but are not limited to, the following:

Any therapy type that is evidence-based and utilized for the purposes of diagnosis and treatment of mental health conditions should be covered by United plans.

What kinds of therapy does United not cover?

Like most insurances, it is not typical for United to cover services unrelated to a diagnosable mental health condition, such as:

  • Couples counseling – Couples counseling is typically not covered by insurance, because relationship issues, while a significant source of stress, are not considered a diagnosable mental health condition.
  • Life coaching – Life coaching is not covered by insurance because it focuses on achieving personal goals, rather than treating a diagnosable mental health condition.
  • Career coaching –  Career coaching is not covered by insurance because it focuses on achieving professional goals, rather than treating a diagnosable mental health condition.

United is also unlikely to cover therapy sessions occurring outside the therapy office, because of the greater potential for risk involved.

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While clients may sometimes benefit from services rendered outside of the therapy office, such as a client with an eating disorder needing support in the grocery store, or a client with a phobia of driving needing support in the car, these services are not likely to be covered by insurance and must be paid for out-of-pocket.

Does United Behavioral Health cover couples therapy?

No. While it depends on your specific plan, it is unlikely that United will cover couples counseling.

That said, even if your insurance doesn’t directly cover it, you still have options for getting affordable couples counseling. Here are five ways to pay for couples counseling if it’s not included in your health insurance plan.

Do I need to see my doctor before visiting an United therapist?

If you need to see your primary care doctor before visiting a United therapist depends on your insurance plan type:

  • HMO or POS plan: Yes, you are typically required to see your primary care physician for a referral to therapy before United will pay for services
  • PPO or EPO plan: No, you typically don’t need to see your primary care physician for a referral to therapy before United will pay for services.

This referral requirement is also called pre-authorization (or prior authorization). Pre-authorization is a process where a health provider, in this case your therapist, must get approval from your insurance company before providing you with care in order for the services to be covered.

Your Summary of Benefits should indicate whether you need pre-authorization for outpatient mental health services.

Does United Behavioral Health cover online therapy?

Yes, United does usually cover video therapy sessions, which you can use in place of an in-person visit to your therapist’s office.

Video sessions are also an option for managing medications without an office visit.

UnitedHealthcare Medicare for Therapy

UnitedHealthcare is one of the largest health insurance companies in the country, insuring nearly 10% of the market. They offer many Medicare plans, which take the federal and state Medicare program and add its own coverage and benefits. Instead of getting Medicare directly through your state, individuals can sign up for a Medicare plan through UnitedHealthcare, which opens up their networks to include thousands of excellent therapists.

Does UnitedHealthcare Medicare cover therapy?

Yes, UnitedHealthcare Medicare provides coverage for mental health services including therapy with a qualified professional. UnitedHealthcare dedicates itself to providing care for the whole person, which includes finding emotional wellbeing. For this reason, and because of the federal Medicare mental health policy, UnitedHealthcare Medicare includes many mental health benefits.

However, the amount of coverage for each therapy session will vary based on your specific UnitedHealthcare Medicare plan.

How do I check if my UnitedHealthcare Medicare plan covers therapy?

Each UnitedHealthcare plan comes with its own Summary and Benefits document. The Summary and Benefits document lists out the coverage provided for each service type, usually in a line-by-line format. This makes it easy for you to figure out how much therapy coverage your UnitedHealthcare Medicare plan allows — and to calculate how much therapy will cost you. When you find your Summary and Benefits document, which is generally found online through your UnitedHealthcare portal, look for the “mental health outpatient” line. There, you’ll find the coverage rates for both in-network and out-of-network therapy visits.

Example UnitedHealthcare Medicare Summary of Benefits, with outpatient and virtual mental health section highlighted

You might also call the phone number on the back of your UnitedHealthcare Medicare card to learn more about your specific plan details and mental health benefits coverage. You’ll speak with a UnitedHealthcare customer service representative who can answer your questions.

How much does therapy cost with my UnitedHealthcare Medicare plan?

Expect to pay a copayment of between $10 – $60 each time you see your in-network UnitedHealthcare Medicare therapist. UnitedHealthcare Medicare provides less coverage for out-of-network therapists, so you may find your costs increasing if you choose to see a therapist that is not within the UnitedHealthcare network.

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The cost per therapy visit using your UnitedHealthcare Medicare plan will vary based on your location, UnitedHealthcare Medicare plan, and your provider’s status. Because Medicare is a state-run program, your UnitedHealthcare Medicare plan will look differently depending on what state you call home.

You may also be required to obtain preauthorization before starting to see your therapist. UnitedHealthcare may approve you for a certain number of therapy sessions that they’ll cover, then the rest may be up to you to pay for out-of-pocket.

What types of mental health conditions does UnitedHealthcare Medicare cover?

UnitedHealthcare prioritizes mental health for its members and wants therapy to be accessible for all. To this point, UnitedHealthcare Medicare health insurance plans provide coverage for a wide range of mental health conditions. These conditions include:

When you start therapy, your therapist will designate a diagnosis for your condition, situation, or goals. They’ll share this diagnosis with UnitedHealthcare as a way of accounting for coverage. If you would prefer that your therapist doesn’t disclose your diagnosis with UnitedHealthcare, consider your out-of-network options. This way, your mental health care stays between you and your therapist — not the insurance company and anyone who has access to your insurance account information.

What types of therapy does UnitedHealthcare Medicare cover?

It’s important and vital to UnitedHealthcare that all mental healthcare is based on evidence, clinical rigor, and the given diagnosis. This is a way of ensuring appropriate care and reimbursement for each of its members. They provide coverage for all therapy modalities proven to reach healthy and desired outcomes, including:

Often, therapists use blended methods as they individualize treatment for each client. As long as the therapist is professionally credentialed and provides appropriate therapeutic services, UnitedHealthcare will cover therapy sessions.

What types of therapy does UnitedHealthcare Medicare NOT cover?

If a therapy approach is not evidence-based — that is, it lacks empirical research backing its efficacy — UnitedHealthcare Medicare will not cover therapy costs.

This includes life coaching and career coaching, as these disciplines are less based on mental health diagnosis and more on goal-setting and achievement. UnitedHealthcare Medicare does not cover holistic approaches to treatment such as aromatherapy, massage therapy, or nutritional therapy. They also do not cover ketamine and psychedelic treatments, even if the purpose of this treatment is for a mental health condition. UnitedHealthcare Medicare does not cover energy work such as reiki healing.

Does UnitedHealthcare Medicare cover online therapy?

Yes, UnitedHealthcare Medicare provides coverage for online therapy and telehealth. You will find that your coverage will remain the same for all visit types, both in-person and online. This means that you’ll have the same copayments and coinsurance rates if you see your therapist through a virtual platform as if you saw them at their office.

Seeing a therapist online is a great way to add therapy into a packed or limited schedule. It also makes it easier to access, as you can speak with your therapist from the comfort of your own home. UnitedHealthcare Medicare recognizes these benefits and therefore offers its members use of teletherapy services.

Does UnitedHealthcare Medicare cover couples therapy?

No, UnitedHealthcare Medicare does not provide coverage for couples therapy. The majority of health insurance plans do not offer this as a benefit. This is in part because it is difficult for the therapist to bill for reimbursement under the required mental health condition diagnosis.

If you’re still interested in couples therapy, there are many ways to make it more affordable. This opens the door for you and your partner or partners to work with a high-quality couples therapist and grow your relationships.

Do I need to see my primary doctor before starting therapy?

You may need to see your primary care physician before starting therapy, depending on your UnitedHealthcare Medicare plan. The UnitedHealthcare Medicare therapy requirements vary based on your state and the exact details of your plan, so be sure to check whether you need to attain a referral for therapy services before you begin your search. In general, if you have a HMO health insurance plan, you will need a referral and therefore need to visit with your primary care physician ahead of your therapy visits.

However, if your UnitedHealthcare Medicare plan does not require a referral — such as PPO or EPO plans —  you can begin your search for a great therapist as soon as you’re ready!

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