Allied Benefit Systems for Therapy

Allied Benefit Systems is a third-party administrator (TPA) for health insurance, which means that they handle insurance benefits offered to employees through their employers. While not technically a health insurance company — which is why it’s called a “national healthcare solutions company” — they make it easier for individuals to access healthcare benefits, including mental healthcare benefits.

Does Allied Benefit Systems cover therapy?

Some Allied Benefit Systems plans offer coverage for mental health services, however not all plans have this benefit — so it’s important to check whether your specific plan offers coverage. For the plans that offer coverage for mental health services, including therapy, you’ll have the option to choose between two different types of providers: in-network providers and out-of-network providers. You might also be able to pick a provider within your specific employer network if you work for an employer that provides services (i.e., hospitals). You’ll receive different amounts of coverage depending on the type of provider that you choose.

How do I check if my Allied Benefit Systems plan covers therapy?

Because not all Allied Benefit Systems plans cover therapy, it’s important to check your Summary of Benefits document for your coverage rates. To find this document, access your online Allied Benefit Systems account through their website. There, you can learn more about your specific plan. You can also ask your company’s HR team to locate and share this document with you, as they’ll have a deeper understanding of your employer’s benefits.

Another way to learn more about whether or not your Allied Benefit Systems plan covers therapy is to call the number on the back of your insurance card. This number will connect you to a customer service representative who can take you step-by-step through your benefits. They can also answer any other insurance-related questions that you have or help you find a list of the in-network providers from which you can choose a therapist.

How much does therapy cost with my Allied Benefit Systems plan?

Some plans will charge you a $10-30 copay per session with your therapist if they’re an in-network provider for Allied Benefit Systems. You might also be responsible for a 20-30% coinsurance, which means that you’ll need to pay that percentage of the session fee out-of-pocket. The session fee is the cost per session with your therapist — so if your therapist charges more per session, you’ll need to pay more.

For out-of-network therapists, you will need to pay more than if you see an in-network therapist. This could look like 40-50% coinsurance, meaning that you’ll likely pay close to $100 per session. However, many people decide to see an out-of-network therapist despite the increased cost because it gives them more options —  they can pick a therapist that suits their needs and preferences.

What types of mental health conditions does Allied Benefit Systems cover?

Allied Benefit Systems offers its members coverage for many different mental health conditions, especially those that fall under a specific diagnosis. Sometimes, in order to access your insurance benefits, your therapist will need to give you a diagnosis. This diagnosis will enable the appropriate paperwork to get processed through Allied Benefit Systems.

Some common mental health conditions covered by Allied Benefit Systems include:

What types of therapy does Allied Benefit Systems cover?

Allied Benefit Systems provides coverage for all therapy services facilitated by credentialed mental health professionals, including psychologists, psychiatrists, social workers, licensed professional counselors, nurse practitioners, and more.

To receive your plan’s benefits, you’ll need to find a therapist that offers evidence-based treatments that are appropriate for the reason behind why you’re attending therapy. This could include the following therapeutic modalities:

What types of therapy does Allied Benefit Systems NOT cover?

Allied Benefit Systems does not cover holistic therapies like acupuncture or aromatherapy.  Other examples of ineligible therapies include life coaching (unless offered in conjunction with eligible therapies), hypnosis, and reiki healing. While many people may benefit from these types of therapies, many plans won’t cover them, along with psychedelic therapies like ketamine-assisted therapy. Allied Benefit Systems plans generally do not cover therapy modalities that lack scientific evidence that points towards their efficacy.

Does Allied Benefit Systems cover online therapy?

Yes, Allied Benefit Systems enables many therapists to provide online therapy services. Teletherapy has become a popular option, with many people beginning to see a therapist online in the past several years. When you work with a therapist in an online setting, you’ll still be responsible for paying the same copays and coinsurance rates, as you’re still accessing outpatient services.

Does Allied Benefit Systems cover couples therapy?

Allied Benefit Systems plans typically do not offer couples therapy benefits, It’s very rare for a health insurance plan to cover couples therapy, but because many of the plans offered through Allied Benefit Systems are designed or chosen by an employer, some plans include couples therapy as an added benefit.

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

If your Allied Benefit Systems plan is a PPO plan — as the majority are — then you do not need to see your primary doctor before starting therapy. PPOs are known for their convenience, as you don’t need a referral before you see a specialist, including a therapist, so you can start therapy when you’re ready. However, if your plan is an HMO, you may need to get a referral from your primary doctor before you can use your Allied Benefit Systems’ benefits for therapy.