Optimum for Therapy

Optimum Healthcare is a healthcare company based in Florida that provides insurance plans to individuals, families, and small businesses. They also offer Medicare and Medicaid plans and strive to provide their members with high-quality, affordable health insurance.

Does Optimum Healthcare cover therapy?

Yes, Optimum Healthcare plans do provide coverage for mental health services like therapy. They mainly provide benefits when you work with an in-network therapist, though some of their plans also provide benefits for visits with an out-of-network provider. Using your Optimum Healthcare insurance plan means that you’ll pay less out-of-pocket for your mental health care.

How do I check if my Optimum Healthcare plan covers therapy?

To check if your Optimum Healthcare plan covers therapy, locate your Summary of Benefits document. This document lists out how much you’ll pay for specific services, which includes mental health services. Within your Summary of Benefits document, look for the category called “Mental health services” and then under “Outpatient individual therapy visit.” Here, you’ll find how much you’ll need to pay for each visit.

If you receive your Optimum Healthcare insurance plan through your employer, you might acquire your Summary of Benefits document through your HR team. Otherwise, you can call the number on the back of your insurance card to ask an Optimum Healthcare representative for more information.

How much does therapy cost with my Optimum Healthcare plan?

Because Optimum has many different insurance plans available for individuals, families, and companies, there is no one cost for therapy. Some plans require payment of a copay, which is an amount that you’ll pay each time you work with your therapist. You can expect to pay a copay between $15-$35 per session.

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 Optimum Healthcare cover?

Optimum Healthcare’s mental health benefits include coverage for therapy services related to the following mental health conditions and life situations, as well as many more:

When you start therapy with a therapist, they will need to provide you with a diagnosis. They’ll share this diagnosis with the insurance company, which enables the reimbursement. This is essential for coverage of your therapy sessions, so if you prefer not to receive a diagnosis, you might consider paying privately for therapy.

What types of therapy does Optimum Healthcare cover?

Optimum covers many different evidence-based therapy approaches and modalities that are tied to your specific diagnosis or life situation. This includes but is not limited to:

Many therapists blend their therapy approaches to provide individualized treatment. This is often called “eclectic” or “integrative” therapy, which simply means that they draw from many different modalities in their work with clients.

What types of therapy does Optimum Healthcare NOT cover?

Optimum Healthcare does not cover therapy services that are not evidence-based and with scientific research to back up its efficacy. They require that all therapy services utilize approaches that are shown to be effective, so therapy modalities like life coaching or career coaching do not qualify for coverage. Health insurance plans generally do not cover therapies like 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.

This is not to say that these therapy approaches aren’t helpful — for many people, they are incredibly impactful on their mental health. However, if a therapist solely provides these approaches, then they are not eligible for reimbursement.

Does Optimum Healthcare cover online therapy?

Yes, Optimum Healthcare covers online therapy. The coverage offered for online therapy sessions is the same as the coverage granted for in-person visits, so there will be no changes to your copay. If you pay a $15 copay for in-person sessions, then you’ll also pay $15 for online sessions.

Does Optimum Healthcare cover couples therapy?

No, Optimum Healthcare insurance plans do not cover couples therapy sessions, though they do provide coverage for group therapy sessions. Generally health insurance does not cover couples’ services, though it depends on your plan. To confirm that there is no coverage for couples therapy, call the customer service number available for your plan.

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

Whether you need to see your primary doctor before starting therapy depends on your specific Optimum Healthcare plan. If your plan is a Health Maintenance Organizations (HMO), you will need a referral from your primary care physician before seeing a therapist. This is because therapists are considered specialists.

For other plans, such as Preferred Provider Organizations (PPO) do not require a referral and you can begin therapy as soon as you’re ready to find your best fit therapist.