How Health Insurance Works for Therapy: And How We Make It Easier at Horn Counseling
Let’s be honest—insurance can feel like a tangled mess of fine print, jargon, and frustrating phone calls. And when you’re already navigating something as personal as therapy, the last thing you need is confusion about how to pay for it.
At Horn Counseling, we believe therapy should be as accessible and affordable as possible. That’s why we offer the option to use health insurance. Whether your therapist is in-network or out-of-network, we’re here to help you make the most of your benefits.
But here’s the deal: every insurance plan is unique. We want you to feel empowered to understand your individual plan and access affordable therapy services.
Let’s break it all down—plain and simple.
What You Need to Know About Insurance & Therapy
1. Therapy Must Be “Medically Necessary”
Most insurance companies will only pay for therapy if it’s considered medically necessary. In practical terms, this means your therapist must provide a mental health diagnosis, but only if one is present and clinically appropriate. That diagnosis must come from the Diagnostic and Statistical Manual of Mental Disorders (DSM), which is the standard tool used in the mental health field.
Here’s where things can get confusing: not everyone who seeks therapy has a diagnosable mental health condition. You might be working through relationship challenges, adjusting to a big life change, or just wanting to grow as a person. Those are all incredibly valid reasons to come to therapy, but they may not meet your insurance company’s criteria for coverage, unfortunately.
And ethically, your therapist can’t assign you a diagnosis just to help you use insurance. Doing so could put their license at risk and compromise the trust and integrity of the therapy process.
At Horn Counseling, we’re committed to providing honest, ethical care. We’ll always talk with you about whether a diagnosis is clinically appropriate and help you explore options if your goals fall outside what insurance will cover.
2. What About Couples or Premarital Therapy?
This one’s important: Insurance rarely covers couples or premarital counseling unless one partner meets criteria for a mental health diagnosis, and the therapy is primarily focused on that person’s treatment.
So if you’re hoping to improve communication, build trust, or work on your connection as a couple, those are all meaningful goals, but they probably don’t meet the medical necessity requirements insurance companies set.
If you’re not sure how your plan treats couples therapy, reach out to your health insurance company and ask.
3. Your Diagnosis Becomes Part of Your Health Record
When you use your insurance, any diagnosis you receive becomes part of your official medical history.
Under the Affordable Care Act (ACA), insurance companies cannot deny you coverage or raise your rates based on a pre-existing condition, including mental health diagnoses. However, mental health records can still play a role in some private insurance policies (like life or disability insurance), so it’s still wise to understand what’s being documented.
This doesn’t mean you shouldn’t use your benefits—it just means it’s smart to go in with your eyes open.
4. Using Insurance Means Sharing Some Info
When you file therapy through insurance, you’re also giving your provider access to certain parts of your mental health record. That can include your diagnosis, session dates, and—sometimes—clinical notes.
If your insurance company ever requests records, Horn Counseling will always notify you first. We’re committed to protecting your privacy and will never share more than what’s absolutely required.
Informed Consent: What You’re Agreeing To
We want you to feel fully informed about your care.
When you choose to use health insurance to pay for therapy, you're also agreeing to the terms set by your insurance company. This includes sharing certain health information, receiving a diagnosis (when applicable), and understanding that not all services—like relationship coaching or personal growth work—are covered.
Your therapist will walk you through all of this at intake so you can make the choice that’s best for your care and your values.
How We Work With Insurance at Horn Counseling
We’ve designed our process to take the guesswork out of insurance, so you can focus on the real work: healing, growing, and thriving.
1. Upload Your Insurance Info
Once you complete your intake paperwork in your secure client portal, you’ll be asked to upload photos of your insurance card. Your therapist will review your goals and concerns in your first session or two, and—if needed—determine a DSM diagnosis that meets insurance criteria.
2. If You’re Out-of-Network, We’ll Still Help You Get Reimbursed
If your therapist is not in-network with your plan, there’s still good news. Many insurance plans offer out-of-network reimbursement or will apply the cost of therapy toward your deductible.
To help with this, we’ll provide a Superbill—a special receipt that includes everything your insurance company needs to process your claim.
Check out our quick Superbill guide here:
What is a Superbill? (And How to Use It)
You can download your Superbill anytime from your client portal and submit it to your insurance company for possible reimbursement.
3. If You’re In-Network, We’ll Handle It For You
If your therapist is in-network with your insurance plan, we’ll file claims for you. After a diagnosis is determined, we’ll submit the information to your insurance company and wait for the Remittance Report (that’s the official breakdown of what your plan covered and what you owe).
Your therapist will walk you through the coverage at your next session. Because deductibles and out-of-pocket maximums reset each year, your costs might change during the year but, we’ll keep you updated every step of the way.
A Few Final Tips to Make the Most of Your Coverage
Each therapist is contracted with different insurance companies.
Email us at hello@horncounseling.org, and we’ll send you an updated list of which therapists are in-network with your plan.We don’t verify benefits.
We want to give you accurate numbers, not guesses. That’s why we wait for the official Remittance Report from your insurance provider after your first claim has been processed. If you would like an estimate, you can reach out to your insurance company to get that information.Want to call your insurance yourself? Great idea.
Here’s a simple script and checklist to help you get clear answers.
Insurance Call Script & Checklist
“Hi, I’m calling to check my outpatient mental health coverage. Can you tell me:
- What is my mental health deductible, and have I met it?
- What is my copay or coinsurance for each therapy session?
- Is pre-authorization or a referral required?
- Do you cover telehealth therapy sessions?
- How many sessions are covered per year?
- Do I have out-of-network benefits?
- What documentation do I need to submit for reimbursement (if out-of-network)?”
Tip: Take notes during your call and ask for a reference number!
Questions? We’ve Got Your Back.
Our team is always happy to help you get clarity around your insurance options. Reach out to us anytime at hello@horncounseling.org.
We want you to get the care you need, with as little stress as possible. Whether you're using insurance or paying out of pocket, we’re here to walk alongside you every step of the way.
