Health Plans Inc. for Therapy
Health Plans Inc., also called HPI, is a self-funded third-party administrator (TPA) that is owned by Harvard Pilgrim, a major healthcare insurance company. Employers pay for Health Plans Inc. to manage the plans offered to their employees, including the plan’s mental health benefits.
Does Health Plans Inc. cover therapy?
Yes, many Health Plans Inc. plans cover therapy services with a credentialed mental health provider. They offer both in-network and out-of-network benefits, which means that you can utilize your benefits even with therapists that aren’t Health Plans Inc. providers.
One of the reasons that employers pick TPAs like Health Plans Inc. to administer their employee’s health benefits is because they can customize their coverage options. This means that each Health Plans Inc. plan offers a different level of coverage, including coverage for mental health services. It’s important to know your specific plan’s benefits before you start therapy so you aren’t surprised with which costs are your responsibility.
How do I check if my Health Plans Inc. plan covers therapy?
Because your Health Plans Inc. plan is likely provided by your employer, you can start to learn about your benefits from reaching out to your company’s HR office. They may have materials to share with you that provide you with information about your plan. You can also log into your Health Plans Inc. member’s portal on their website. Through this portal, search for your plan’s Summary of Benefits document. The Summary of Benefits document lays out the costs for each service category, including in-network and out-of-network coverage. Here, you can see if you’ll be responsible for a copay or coinsurance. Look for the section called “If you need mental health, behavioral health, substance abuse services.”
If these options prove difficult, you can give the Health Plans Inc. customer service hotline a call to ask them about your specific mental health coverage. You can find the hotline’s phone number on the back of your insurance card.
How much does therapy cost with my Health Plans Inc. plan?
Keeping in mind that each Health Plans Inc. plan offers different coverage for therapy services, you can expect to pay a small copay or coinsurance each session with your therapist. Copays can be as low as $7. Other plans offer 10-30% coinsurance rates. The amount of these copays or the amount of coinsurance you’re responsible for depends on whether you see an in-network therapist or an out-of-network therapist, with higher costs for seeing an out-of-network therapist.
Some employers want to encourage their employees to take care of their emotional health. These employers may offer greater mental health benefits, including Employment Assistance Program support. Check with your employer if they offer additional resources.
What types of mental health conditions does Health Plans Inc. cover?
Health Plans Inc. plans provide coverage for many different mental health conditions, including all mental health conditions that receive a specific diagnosis through either of the regular diagnostic tools generally used in the mental health field. After a few sessions, your therapist will provide you with a diagnosis which is used in billing and reimbursement processing. You may request that your therapist refrain from disclosing your diagnosis to you, however they must disclose your diagnosis to Health Plans Inc.
Health Plans Inc. covers many diagnoses and mental health conditions, including:
What types of therapy does Health Plans Inc. cover?
Health Plans Inc. covers therapy that’s appropriate for your specific diagnosis. Your therapist will need to share with Health Plans Inc. what type of therapy they’re providing during your sessions, and Health Plans Inc. will ensure that they’re providing therapy that shows efficacy. Health Plans Inc. only covers therapy modalities that show great scientific evidence that they benefit clients in the mental health setting. They also require that the therapy is provided by a credentialed professional mental health provider.
Some common therapy approaches covered by Health Plans Inc. include:
- Cognitive Behavioral Therapy (CBT)
- Dialectical Behavioral Therapy (DBT)
- Exposure and Response Prevention Therapy
- Internal Family Systems (IFS)
- Eye Movement Desensitization and Reprocessing (EMDR)Acceptance and Commitment Therapy (ACT)
Your therapist may offer the above or any other evidence-based therapy modality in conjunction with other therapy approaches. As long as they can justify to Health Plans Inc. that they’re providing appropriate care, you can utilize your insurance benefits.
What types of therapy does Health Plans Inc. NOT cover?
Health Plans Inc. do not cover therapy approaches that do not show clinical rigor. With more research happening on new and innovative therapy approaches, many approaches previously seen as “non traditional” are now covered. However, approaches like reiki healing or other energy work do not meet the scientific standard for reimbursement. This also includes life coaching, as many life coaches do not have the proper credentials to provide the level of therapy required to reach Health Plans Inc.’s standards.
Does Health Plans Inc. cover online therapy?
Yes, many Health Plans Inc. cover online therapy to keep up with the general trend of teletherapy offerings through healthcare insurance companies. If you see your therapist online instead of in-person, you’ll receive the same amount of coverage, including the same copay or coinsurance rate.
Does Health Plans Inc. cover couples therapy?
Many Health Plans Inc. plans do not cover couples therapy. As stated earlier, coverage requires a specific diagnosis, which is not available for couples. Without a diagnosis, Health Plans Inc. cannot code reimbursements and therefore cannot offer coverage. Check with your employer if they offer any specific benefits for couples, as some employers opt in to plans that include this type of service.
If you would still like to see a couples therapist with your partner or partners, couples counseling can still be accessible through other low cost options. You can also plan to see your therapist once a month instead of weekly as a way to lower your costs.
Do I need to see my primary doctor before starting therapy?
Depending on your type of Health Plans Inc. plan, you may need to see your primary doctor before starting therapy. HMO plans require a referral from your primary doctor or another provider before you can access your mental health benefits. PPO plans, however, do not require a referral. PPO plans make it less of an administrative burden to get set up with a therapist and start working on your mental health.