Is therapy covered by kaiser insurance

Deborah C. Escalante

You’ll get a personalized mental health treatment plan. You may need to try several options before you figure out what works for you — that’s a normal part of the process. We’ll help guide you through your options, based on your situation and personal preferences.

Types of mental health services and resources

Individual therapy

One-on-one, confidential sessions where a therapist will help you explore and understand your thoughts, feelings, and behaviors, and how you can take proactive steps to feel better.

Therapy at Kaiser Permanente is collaborative and results-oriented — you and your therapist will work together to achieve your specific goals. The duration of individual therapy depends on what you need and how you’re doing. Once you achieve your goals and get the tools and insights you need to feel mentally and emotionally strong, you no longer need to see a therapist. 

Psychiatry

One-on-one, confidential sessions with a psychiatrist, nurse practitioner, or physician assistant who specializes in mental health treatment, including diagnosing mental health conditions and prescribing medications. Once your condition is stable, your personal doctor might take over managing your medication. 

Group therapy

Meetings led by mental health professionals, where members with similar experiences or conditions support each other to reach common wellness goals. It’s an opportunity to learn from and connect with others — which many people find extremely powerful — and you don’t have to share anything you’re not comfortable with.

Health classes

Programs taught by trained instructors, designed to help you strengthen relationships, change unhealthy thinking and behavior, cope with stress, and more.

Self-care resources

Tools that empower you and support a healthy mindset, including online self-assessments, Wellness Coaching by Phone, personalized healthy lifestyle programs, and more.

Kaiser Permanente PPO for Therapy

Kaiser Permanente PPO is a health insurance plan offered by Kaiser Permanente, a major managed health care consortium with reach across the country that strongly believes in the importance of whole-person care and enhanced mental healthcare access. Kaiser Permanente offers HMO, EPO, and PPO health insurance plans. With the Kaiser PPO plan, you get access to the large PHCS Kaiser Permanente provider network — which has over 750,000 providers! — or you can see any licensed provider without needing a referral first. The network includes thousands of excellent therapists ready to help you with your mental health journey.

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Does Kaiser Permanente PPO cover therapy?

Yes. Kaiser PPO offers coverage for mental health services including therapy. Kaiser Permanente PPO has an extensive network of therapists to choose from, giving you the opportunity to find the therapist that’s just right for you. If you choose to see a therapist outside of the Kaiser Permanente PPO’s in-network provider list, you’ll still receive some coverage — which makes seeing a therapist budget-friendly no matter the therapist’s provider status.

There are four PPO plans offered by Kaiser (Bronze, Silver, Gold, Platinum) that vary in their therapy benefits; however, all include mental health coverage in their plans. It’s important to understand the specific details of your Kaiser Permanente PPO plan before beginning therapy so you have an accurate picture of what it will cost you.

How do I check if my Kaiser Permanente PPO plan covers therapy?

To determine if your Kaiser PPO plan covers therapy, visit your Summary and Benefits document through your online Kaiser Permanente PPO account portal. Within this document, you’ll find “outpatient services” under the behavioral and mental health section — this is where your coverage information will be.

Example Kaiser Permanente PPO Summary of Benefits, with Outpatient Mental Health section highlighted

If you cannot locate your Summary and Benefits document or still have questions about your mental health benefits, call the customer service number on the back of your insurance card. Through this hotline, you’ll speak with a Kaiser Permanente PPO customer service representative who can assist you.

How much does therapy cost with my Kaiser Permanente PPO plan?

While therapy costs will vary based on which plan you have, expect to pay a copayment of between $15 – $65 for each therapy visit with an in-network therapist. If you see an out-of-network therapist, you’ll be responsible for a coinsurance of 30% – 100% per visit. The coinsurance rate describes the amount of the session fee for which you’re responsible. This means that it’s often much more cost-effective to see a therapist that’s in-network with your Kaiser Permanente PPO plan.

If you’re concerned about paying for therapy, ask your therapist about sliding scale options. If your therapist offers sliding scale payments, you may be eligible to pay a lowered fee per session.

What types of mental health conditions does Kaiser Permanente PPO cover?

Kaiser Permanente PPO believes that mental health is vital for overall wellness. Because of that belief, they provide coverage for a wide range of mental health conditions. These conditions include:

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When you start therapy, your therapist will designate a diagnosis for your condition or goals. They’ll share this diagnosis with Kaiser Permanente PPO to ensure coverage. If you would prefer that your therapist doesn’t disclose your diagnosis with Kaiser Permanente PPO, 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 Kaiser Permanente PPO cover?

Kaiser Permanente PPO reimburses for many different evidence-based therapy approaches and modalities. This includes but is not limited to:

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, Kaiser Permanente PPO will cover therapy sessions.

What types of therapy does Kaiser Permanente PPO NOT cover?

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

This includes life coaching and career coaching, as these disciplines are less based on the mental health literature and more on goal-setting and achievement. Kaiser Permanente PPO does not cover holistic approaches to treatment such as aromatherapy, massage therapy, acupuncture, 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.

However, Kaiser Permanente does offer an acupuncture plan, so if you’re interested in receiving this service as a supplement to your mental health treatment, you may find this plan appealing.

Does Kaiser Permanente PPO cover online therapy?

Yes, Kaiser Permanente PPO covers online therapy. Many clients prefer to see their therapist regularly online, rather than in-person — whether it’s for convenience or accessibility. Therapists in-network with Kaiser Permanente PPO must use a secure video platform for each therapy session, which ensures that each client’s information remains safe. The costs and coverage for therapy services will remain the same, no matter if the client sees their therapist online or in-person.

Does Kaiser Permanente PPO cover couples therapy?

Kaiser Permanente PPO does not cover couples therapy — however, it does cover family therapy, which may be relevant for some clients. Many health insurance companies do not offer couples therapy benefits for their members. This may be because it’s difficult to provide a diagnosis for a couple, rather than an individual, and this diagnosis is a requirement for reimbursement.

There are still ways to access couples counseling even if your insurance does not cover it: here are five ways to pay for couples counseling.

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

No, you do not need to see your primary care physician before starting therapy with your Kaiser Permanente PPO plan. Having a PPO plan not only lowers many of your out-of-pocket expenses but also gives you the opportunity to search for a high-quality therapist as soon as you’re ready.

Your first step is to call us. You’ll either talk to someone from our mental health care team at that time or schedule an initial assessment for a later date. During your assessment, you’ll talk about what you’re experiencing, why you’re seeking care, things you can do now to support your mental health, and what you hope to achieve through treatment. Your answers will help us figure out what type of care will be most helpful for you — whether you need tools and resources for healthy living, therapy, medication, or a combination of treatments. Click here to understand your care options.

Depending on where you live and the care you need, there’s a chance that you might get care outside of Kaiser Permanente. The demand for mental health care is higher than ever — so we work with outside providers who we trust to make sure members can access the support they need.
 

Yes, health insurance plans from Kaiser cover therapy, counseling, and other mental health support benefits.

Here’s an easy way to find Kaiser therapy coverage by viewing therapists who take Kaiser insurance in your area.

You can use the online booking tool for in-person sessions or telehealth video therapy appointments with Kaiser Permanente therapists. There are even many Kaiser therapists who offer free 15-minute initial consultations.

Kaiser Permanente therapy coverage options

If you’re wondering: “Does Kaiser Permanente cover therapy?” “Does Kaiser HMO cover therapy?” “Does Kaiser cover therapy?” or “Does Kaiser offer therapy?” We have some good news.

Kaiser Permanente insurance plans cover a wide range of mental health and addiction care options.

And, with Kaiser coverage, you don’t need a referral from your Kaiser primary care doctor to access therapy, mental health and addiction care services.

Kaiser therapy coverage can help with a variety of concerns

Health insurance plans with Kaiser offer therapy as well as treatment and support for mental and emotional conditions as well as and substance use.

Under the Affordable Care Act (ACA), mental and behavioral health treatment must be covered as essential health benefits. These benefits include counseling and therapy, as well as inpatient mental and behavioral health care and substance abuse treatment. 

Almost all mental disorders, as well as substance use disorders and alcohol and chemical dependency treatment, are covered by all ACA-compliant health insurance, including Kaiser plans.

However, since insurance coverage is based on medical necessity, Kaiser Permanente may have more limited coverage options for issues such as grief and loss, couples and marriage counseling, and general relationship issues.

Tips to find Kaiser therapists near you

The Monarch Directory by SimplePractice can help you view all therapists who accept Kaiser Permanente.

Many Kaiser therapists have online booking for in-person sessions or telehealth video appointments, and many also offer free 15-minute initial consultations.

Whether you’re experiencing anxiety, depression, ADHD, or other mental health concerns, here are more tips to find a therapist who takes your health insurance.

Finally, if you’re looking for a way to find affordable therapy and quality mental health care, here are some affordable, low-cost—and even free—therapy options.

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