Evernorth for Therapy
Evernorth brings a modern twist to the healthcare game, offering flexible pharmacy, care, and benefit solutions. They’re affiliated with Cigna, a major healthcare insurance company, and create innovative ways to make healthcare accessible — including mental healthcare.
Does Evernorth cover therapy?
Yes, Evernorth covers therapy services for their members. As a company, Evernorth is dedicated to helping its members with behavioral health, with many solutions created for this purpose, including case management programs, Employer Access Programs (EAPs), concierge behavioral navigation, and their Cognitive Behavioral Therapy and Medication Management program called inMynd.
How do I check if my Evernorth plan covers therapy?
To check if your Evernorth plan covers mental health services, locate your Summary of Benefits document. This may be available through your Evernorth online portal, or you may have gotten it from your employer should you receive your Evernorth plan through them.
In your Summary of Benefits, look for the section titled “If you need mental health, behavioral health, or substance abuse services.” You’ll see that this section is broken into in-network providers and out-of-network providers. You’ll pay less out-of-pocket when you see a therapist that’s in-network with Evernorth, which uses the Cigna network.
If you cannot find this document, you can call the customer service hotline number on the back of your insurance card and ask them about your therapy benefits.
How much does therapy cost with my Evernorth plan?
The cost for therapy depends on which plan you have with Evernorth. Because Evernorth provides plans across the country, they offer different coverage depending on location and plan type. However, you can expect to pay a coinsurance of around 10% for sessions with in-network therapists and 30% for sessions with out-of-network therapists. Coinsurance is the amount of the bill that you’re responsible for out-of-pocket, so if your therapist charges $200 per session and your plan has a 10% consinsurance, you’ll need to pay $20 each session.
However, the least expensive option is to utilize your employer’s EAP services, which may be provided through Evernorth. These services are generally short term, and there may be a limit to the number of sessions that you have with the EAP counselor or coach. However, they can help you connect with another therapist for more long term care.
What types of mental health conditions does Evernorth cover?
Evernorth plans cover therapy for many mental health conditions, all of which need to be diagnosable by a credentialed mental health professional. As with most healthcare insurance plans, Evernorth requires that its members receive a diagnosis from their therapist to access their benefits.
Examples of eligible mental health conditions include:
What types of therapy does Evernorth cover?
To access your Evernorth benefits, your therapist must have appropriate mental health credentials and have a license in your state. They must practice evidence-based therapy approaches that are proven to benefit individuals in a clinical setting. Some examples of evidence-based therapy modalities include:
- Cognitive Behavioral Therapy (CBT)
- Dialectical Behavioral Therapy (DBT)
- Eye Movement Desensitization and Reprocessing (EMDR)
- Mindfulness practices
- Child-parent psychotherapy
- Acceptance and Commitment Therapy (ACT)
There are many more types of therapies, and generally therapists will offer “eclectic” or “integrative” therapy that blends more than one approach based on your needs. Evernorth recommends that its members access CBT, even offering access to inMynd, their CBT program, to members on certain plans.
What types of therapy does Evernorth NOT cover?
As with other health insurance companies, Evernorth does not cover life coaching, career counseling, or holistic treatment modalities like aromatherapy under their outpatient mental health benefits. It also does not cover energy work such as reiki healing.
However, through Evernorth’s EAP, you can receive career or life coaching services. These services are separate benefits on your plan, and are only available to those who have EAP services offered on their plans.
Does Evernorth cover online therapy?
Yes, Evernorth covers online therapy. Evernorth prides itself on being a modern, contemporary solution for its members, offering all services through telehealth beginning in 2021. This means that you can see your therapist online, rather than going in-person, which not only saves you time but can also help you focus on your wellbeing. Many individuals access online therapy because it means they can stay in the comfort and safety of their homes while speaking with their therapist.
Does Evernorth cover couples therapy?
When you have access to Evernorth’s EAP services, you can access a limited number of couples therapy sessions. This is best used as a one-off service, though your EAP counselor can help you find more long term options for couples therapy.
Outside of the EAP service, though, Evernorth does not offer couples therapy benefits. As with many other plans, Evernorth relies on a diagnosis to process reimbursement — and it’s challenging to provide a diagnosis for more than one person.
Do I need to see my primary doctor before starting therapy?
Evernorth offers both PPO and HMO plans, which means that you may or may not need a referral from your primary doctor before starting work with a therapist. They also offer Open Access Plus (OAP) plans, which act like an HMO. For HMO and OAP plans, you will need to see your primary doctor before finding a therapist.