AvMed for Therapy

AvMed has over 50 years of history providing Floridians with individual, family, and company healthcare insurance plans. Their name is a shortened version of Aviation Medicine, as they used to solely insure pilots. In 2023, they were bought by Sentara, a large healthcare insurance company.

Does AvMed cover therapy?

Yes, most AVMed plans offer some coverage for mental health services like therapy. However, not all plans offer this benefit — so it’s important for you to check your plan’s coverage to understand the costs. For some plans, you’ll only receive coverage if you see an in-network therapist. This means that you won’t receive any reimbursement when you work with out-of-network therapists and you’ll be responsible for the whole session fee.

How do I check if my AvMed plan covers therapy?

Because not all AvMed plans offer coverage for therapy, you’ll need to check your specific plan’s offering. The best place to start is your plan’s Summary of Benefits document. If you receive AvMed through your employer, ask your HR team for a copy of your benefits. Otherwise, log into your AvMed account and search the documents section to learn more about your coverage.

Your Summary of Benefits document will show you how much you will need to pay out-of-pocket per session with your therapist. You may have to pay a copay or coinsurance each time you meet with your therapist, and that information will be under a category called “If you need mental health, behavioral health, or substance abuse services.” This category is further broken into in-network and out-of-network providers. You’ll pay the least if you work with an in-network provider and your plan offers coverage.

You can also call the customer service hotline number on the back of your AvMed insurance card if you’re still unclear about your benefits. While on the phone, ask them about your therapy benefits and how much it will cost you to work with a therapist.

How much does therapy cost with my AvMed plan?

Some AvMed plans offer full coverage when you work with an in-network therapist, while others offer no coverage at all, no matter if your therapist is an AvMed provider. If the latter is the case, then you’ll be responsible for paying the full session fee, which could amount to between $150 and $250 per session.

Outside of these two cases, you can expect to pay a copay of between $10 and $50 each time you have a session with your in-network therapist. Because there is such a wide range of benefits under AvMed plans, be sure to understand your coverage before you start working with a therapist so you don’t exceed your budget.

What types of mental health conditions does AvMed cover?

There are many mental health conditions covered by AvMed plans. These mental health conditions include:

To be eligible for AvMed coverage, you will need to receive a diagnosis from a credentialed mental health professional. You can always request your therapist withhold your diagnosis from you, however you may encounter this diagnosis in your AvMed paperwork. AvMed requires a diagnostic code for their billing processes, though it’s important to remember that you are not your diagnosis and your diagnosis does not need to limit you in any way.

What types of therapy does AvMed cover?

Similar to the diagnostic code, AvMed requires your therapist to report an eligible therapy approach used in your sessions. This makes it possible for them to complete their billing processes and reimburse either you or your therapist.

There are many different therapy approaches. The approaches that have scientific evidence pointing towards clinical rigor can be eligible for AvMed coverage. These include, but are not limited to, the following approaches:

What types of therapy does AvMed NOT cover?

Therapy approaches like life coaching, career counseling, energy work, and other modalities whose efficacy is not backed by evidence will not be covered by AvMed plans. Many therapists, however, incorporate elements of the above into their practice. As long as they provide these approaches in conjunction with evidence-based approaches, then they’ll still be able to get reimbursed for their services.

Does AvMed cover online therapy?

Yes, AvMed covers online therapy. The amount of coverage you receive for in-person therapy is the same amount of coverage you’ll receive for online therapy or teletherapy.

AvMed offers its members an app called Savenllo free of charge. This app provides access to many wellbeing resources including tools that can help with anxiety or depression. You can also utilize daily check-ins so you can track your mood or engage with others through the Savenllo community. This app is a great way to access a form of mental health care through a self-paced, digital format.

Does AvMed cover couples therapy?

The majority of AvMed plans do not cover couples therapy. AvMed relies on certain criteria for care to process your benefits, and couples therapy makes it difficult to receive a diagnosis. However, you can work with your therapist in an individual setting to explore ways to improve your relationship, as there are many therapy approaches that can help you communicate more directly, set strong boundaries, or grow your bond with your partner or partners.

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

AvMed offers both HMO and PPOs plans. If you have an HMO plan, you are required to get a referral from your primary doctor before beginning a relationship with a mental health provider. You will need to get a new referral each year to maintain your access to these benefits. If you have an PPO, however, you do not need a referral and can begin working with a therapist as soon as you’re ready and find the right one.