How to use your health insurance for therapy in Arizona
A plain-language walkthrough of deductibles, copays, and the exact questions to ask your insurance company before your first therapy session in Arizona.
Figuring out whether your insurance will pay for therapy should not be harder than deciding to go. Unfortunately, it often is. The cards, the phone trees, and the vocabulary all seem designed to make you give up. This guide walks you through it step by step.
The words you will hear
Insurance has its own language. Here are the five terms that you’ll hear most.
In-network means the therapist has a contract with your insurance company, so you pay the lower, agreed-upon rate. Out-of-network means there is no contract, so you usually pay more, or pay the full fee up front and ask for partial reimbursement.
A deductible is the amount you pay for care each year before your insurance starts paying its share.
A copay is a fixed amount, like $25, that you pay at each visit.
Coinsurance is a percentage of the visit cost, like 20%, that you pay after your deductible is met.
An out-of-pocket maximum is the most you will pay for covered, in-network care in a year, and after you reach it, your plan pays the full cost of that care. It does not include your monthly premium or copays.
Most plans use some mix of these. You might have a copay for therapy with no deductible, or you might pay the full session cost until your deductible is met and then pay coinsurance. The only way to know is to ask.
Step 1: Find your member ID card
Your card is either in your wallet or in your insurance company’s app. Look for the member ID number, the group number, and a phone number on the back labeled “Member Services” or “Behavioral Health.” Some plans use a separate company for mental health benefits, so if you see a different number for behavioral health, call that one.
Step 2: Call or check the app
Many insurance apps now show your mental health benefits directly, including your copay and how much of your deductible you have met. If yours does, you might be able to skip the phone call. If not, call the number on the back of your card and say you want to check your outpatient mental health benefits. Outpatient just means a regular office or video visit, not a hospital stay.
Step 3: Ask these exact questions
Write the answers down as you go, along with the date and the name of the person you spoke with.
- Is outpatient mental health covered under my plan?
- Do I need a referral from my doctor or a prior authorization before I start?
- What is my copay or coinsurance for a 90791 visit, and for a 90837 or 90834 visit? The first is the billing code for an intake, which is the first appointment, and the other two are the codes for a standard individual therapy session. Using them tells the representative exactly what you mean.
- Have I met my deductible this year, and if not, how much is left?
- Is this therapist in-network? Give them my name, Emily Ward, and the name of my practice, EmpowerMind Therapy.
- Are online sessions covered the same way as in-person sessions?
That last question matters more than people expect. Arizona law requires most health plans to cover a video session whenever they would cover the same visit in person. Plans that an employer funds directly follow federal rules instead of state law, so a few can still treat the two differently. I meet with clients both in person and online, so it is worth confirming.
Step 4: Check that I take your plan
I am in-network with several plans, including a couple of employee assistance programs, which are free sessions offered through your employer. The current list is on my insurance and fees page. If you are unsure whether your specific plan is on it, the billing and insurance departments at Mindful Therapy Group, the group that handles my billing, can check for you before you book. Ask them whether Emily Ward at EmpowerMind Therapy is in-network, or contracted, with your insurance.
What if your plan is out-of-network?
You still have options. Many plans reimburse part of the cost of out-of-network therapy once you have met an out-of-network deductible. To claim it, you pay the full session fee, and you receive a document called a superbill. A superbill is a detailed receipt with the codes your insurance company needs. You submit it to them, and they reimburse you for whatever portion your plan covers. Ask the insurance representative on the phone whether your plan has out-of-network mental health benefits and how to submit a claim.
What if you would rather not use insurance?
Some people choose to pay privately, sometimes for privacy reasons and sometimes because their deductible is high enough that it would not help. If that is you, federal law gives you the right to a written Good Faith Estimate of your costs before you start. My private-pay rate is listed on the insurance and fees page.
A few honest things to know
Insurance requires a diagnosis to pay for therapy. Therapists have their own set of diagnoses, and each one refers to a specific situation rather than a verdict on you as a person. That can feel confusing when all you wanted was to talk to someone. If your insurance sends you paperwork with a diagnosis on it and anything about it is unclear, ask me. I will gladly explain what it means.
Benefits reset every year, often in January. If you started therapy in the fall and your sessions suddenly cost more in the new year, your deductible has probably started over.
If a claim gets denied, it is often a paperwork problem rather than a final answer. Call the number on your card and ask why. Many denials get reversed once the missing piece is fixed.
If you want help understanding what your plan will cover, the billing and insurance departments at Mindful Therapy Group can walk through it with you before you commit to anything. If your questions are about therapy itself, I am happy to talk. There is no pressure to book. Getting a clear answer is a good first step on its own.