GHI | Mental Health Insurance Coverage — Zencare

GHI for Therapy

GHI stands for Group Health Incorporated. GHI joined EmblemHealth, another large health insurance company, and offers expansive health insurance plans for individuals, families, and employees including those who work for New York City. GHI provides mental health benefits including coverage for therapy services with in-network and out-of-network therapists.

Does GHI cover therapy?

Yes, GHI provides coverage for therapy visits. This means that you can use your GHI health insurance to decrease your out-of-pocket costs for mental health services. GHI’s coverage includes both in-network and out-of-network therapists, so it doesn’t matter who you see for therapy — as long as they have the appropriate credentials, GHI will help you pay for your therapy.

However, the amount of coverage provided changes depending on the specific GHI plan that you have, so it’s important to understand the details of your exact plan before you start working with a therapist.

How do I check if my GHI plan covers therapy?

To check if your GHI health insurance plan covers therapy services, head over to your Summary and Benefits document. You’ll likely find this document through your online GHI account — because GHI is a part of EmblemHealth, you may have an EmblemHealth account rather than a specific GHI account. You may also have Empire BlueCross BlueShield coverage as part of your GHI plan (generally for New York City employees).  Within this document, you’ll find the different rates of coverage — including copayment or coinsurance amounts — for each type of service available. Look for “mental health” or “behavioral health” to see your coverage for therapy, which will be under “outpatient visits.”

Example GHI Summary of Benefits, with Outpatient Mental Health section highlighted.

If your Summary and Benefits document does not share this information with you, give the phone number on the back of your insurance card a call. The GHI customer service department will share with you the coverage available to you through your plan.

How much does therapy cost with my GHI plan?

Expect to pay a copayment of between $15 - $65 per session for in-network therapists or preferred providers with GHI. For out-of-network therapists, you may have a coinsurance rate of between 20 - 50% coinsurance per session. This means that you’re responsible for that percentage of the session fee — if you see a therapist that charges more per session, you’ll pay proportionally more for their services.

GHI offers many different health insurance plans through EmblemHealth. Their plans may be purchased privately, through an employer, or as part of a state-run program like Medicaid or Medicare. Because of the diversity of their plan offerings, there is no one cost for therapy for GHI members.

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 GHI cover?

GHI covers many mental health conditions, including all mental health conditions that have a specific diagnosis. When you start seeing your therapist, they will provide you with a diagnosis under which you’ll receive reimbursement.

Some common mental health conditions covered by GHI include:

There are many more mental health conditions covered by GHI and your therapist will provide an accurate and appropriate diagnosis for you after your first few sessions.

What types of therapy does GHI cover?

GHI reimburses for all therapy services provided by a credentialed mental health professional. This could include psychologists, psychiatrists, social workers, licensed professional counselors, nurse practitioners, and more.

Therapists need to provide evidence-based, clinically rigorous treatments that are appropriate for the client’s diagnosis. This includes the following therapeutic modalities:

Many therapists blend their approaches in sessions with clients. As long as the therapist meets the GHI or EmblemHealth requirements, then they’ll be eligible for coverage.

What types of therapy does GHI NOT cover?

GHI will not cover any therapies that are not evidence-based or based. This means that GHI requires a certain degree of clinical rigor in the therapist’s treatment. Treatment also needs to be based upon a specific mental health diagnosis. For these reasons, GHI will not cover career counseling or life coaching, as these are generally based on goals rather than a specific mental health condition. GHI also does not cover holistic therapies like nutritional therapy, aromatherapy, massage therapy, or reiki healing.

Does GHI cover online therapy?

Yes, GHI covers online therapy. Whether you choose to see your therapist in-person or through an online platform, your GHI benefits remain the same — you’ll pay the same copayments or coinsurance no matter the location. This broadens access to mental health services for many people, including those who prefer to stay within their homes, those who have packed schedules and cannot commute to see their therapist, and those who have physical limitations.

Does GHI cover couples therapy?

Some GHI plans cover couples counseling. Because there are so many different types of GHI health insurance plans, it’s important to understand your mental health and couples therapy benefits before you start working with a couples therapist. Some plans do not cover couples counseling, in part because GHI requires that each client have a mental health diagnosis to guide treatment — and it’s difficult for a therapist to provide a diagnosis for two people.

However, couples counseling is still possible — and affordable! — for many couples through other options. If you’re still interested in working with a couples therapist, you have the chance to do so without breaking your budget.

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

It depends on your specific GHI plan whether or not you need to see your primary care physician before starting therapy. GHI offers both HMO and PPO plans. If you have an HMO health insurance plan, you will need a referral from your primary care physician before you begin your search for a great therapist. This process is commonplace and should not be a major roadblock to your therapy journey!

However if you have a PPO plan, you do not need a referral from your primary care physician — which means that you can start working with a therapist as soon as you’re ready!