How to Use Insurance for Online Therapy: A Step-by-Step Guide

Insurance can turn online therapy from a weekly expense into a copay, but the process is confusing: plans differ, clinicians are in or out of network, and the price you see online is often not the price you pay. This step-by-step guide shows how to find out what your plan covers, how to check a provider, and what to do if coverage falls short. It uses insurance-based services such as Talkspace and Rula as examples. It is general information, not advice about your specific plan.

If you are in crisis or worried about your immediate safety, see Get Help Now. In the US you can call or text 988, or call 911 in an emergency.

Step 1: Find out what your plan covers

Call the number on your insurance card, or check your member portal, and ask:

• Does my plan cover mental health care delivered by telehealth, and is it the same as in-person?
• What is my copay or coinsurance for a therapy session?
• Do I have a deductible, and how much of it have I met?
• Is there a limit on the number of sessions per year?
• Do I need a referral or prior authorization?
• Do I need a diagnosis for therapy to be covered?

Write down the date, the representative’s name and what they said. If a claim is later denied, that record helps.

Step 2: Understand in-network and out-of-network

An in-network clinician has a contract with your insurer and charges the agreed rate, so you pay a copay or part of that rate. An out-of-network clinician does not, and you may pay more or the full fee. Insurance acceptance varies by state, plan and clinician, even within the same company, so a service that says it takes your insurer may not have an in-network therapist available to you.

Step 3: Check the provider, not just the brand

Many online services list plans they work with. Talkspace says it is in network with plans covering more than 100 million Americans, including select Aetna, Cigna, Optum, Anthem, Premera, Medicare and TRICARE plans, with an average therapy copay of about $10. Rula says it is in network with more than 100 commercial plans and that insured patients pay about $15 a session on average. These are company figures, and your cost depends on your benefits and deductible. See our Talkspace review and Rula review for details.

Not every service bills insurance. BetterHelp offers a subscription at $70 to $100 a week and says it is in network with 125+ plans, with an average $23 copay for eligible members, though not Medicare, Medicaid or TRICARE. Sesame is cash-price and does not bill insurance.

Step 4: Get a cost estimate before your first session

Reputable services show an estimate when you enter your insurance. If yours does not, ask in writing what you will pay for the first and later sessions, and whether the clinician is in network for your specific plan. If a service says your copay is $0 or $10, confirm that it applies after your deductible.

Step 5: Book, and keep your records

After sign-up, you are matched with or choose a clinician licensed in your state. Keep the confirmation, and save emails about pricing. Check your first explanation of benefits (EOB) from your insurer against what you were charged.

What if my plan does not cover online therapy?

You still have options:

• Out-of-network reimbursement: some plans repay part of the fee. Ask the therapist for a superbill, a receipt with codes, and submit it to your insurer.
• HSA and FSA funds: many services accept them.
• Employee assistance program (EAP): often offers a few free sessions.
• Sliding-scale or low-cost care: see affordable mental health care.
• Self-pay services: compare options in our guide to therapy without insurance.

Common problems and fixes

• The therapist is full: ask for a waitlist or check other profiles in the same network.
• A claim is denied: call the insurer, ask for the reason, and appeal if appropriate.
• A bill is higher than expected: check whether your deductible had been met and whether the clinician was in network on the date of service.
• You want therapy and medication: some services offer both, such as Talkspace and Rula, though rules for controlled substances vary by state.

Privacy when you use insurance

Billing insurance means your visits appear on claims, like any healthcare visit. If that concerns you, ask your insurer how explanations of benefits are sent and who can see them, or consider a self-pay service. Read each provider’s privacy policy before you sign up.

Compare services that take insurance

See our best online therapy services guide, or the paid comparison page for the best online therapy services. For lower costs, see affordable therapy. Our Talkspace vs. BetterHelp comparison explains the difference between insurance-based and subscription therapy.

The bottom line

To use insurance for online therapy, confirm your coverage, check that the specific clinician is in network, get a cost estimate and keep records. If coverage falls short, out-of-network reimbursement, HSA or FSA funds, an EAP or a self-pay service can still make therapy affordable. Some links on this page are affiliate links and may earn us a commission, which never affects our conclusions. See our affiliate disclosure.