Healthfirst for Therapy
Healthfirst is a New York-based healthcare insurance company that provides individual, family, and employer plans, including Medicaid and Medicare plans. The Healthfirst network has over 40,000 providers, boasting thousands of high-quality therapists to complement its mental health benefits for members.
Does Healthfirst cover therapy?
Yes, most plans under Healthfirst cover therapy services with licensed therapists. This means that you can save money out-of-pocket when you use your Healthfirst plan as opposed to paying privately. However, Healthfirst offers many different plans, all with different mental health benefits. It’s important that you understand your plan’s exact details when it comes to coverage for therapy before you start therapy so you can avoid any unexpected costs.
How do I check if my Healthfirst plan covers therapy?
To learn more about your Healthfirst plan’s coverage for therapy, locate and read through the Summary of Benefits document associated with your plan. This document breaks down benefits by service type so you can understand how much out-of-pocket cost you’ll be responsible for paying. Look for the category “If you need mental health, behavioral health, or substance abuse services” and then across the row to “Outpatient services.” Here, you’ll find coverage information for both in-network and out-of-network providers.
You can find this document in your Healthfirst online account or, if you receive your Healthfirst plan as an employee benefit, from your HR team. If you’re still unsure if your Healthfirst plan covers therapy services, give the number on the back of your insurance card a call and ask about therapy benefits.
How much does therapy cost with my Healthfirst plan?
While every plan is different, you can expect to pay a $10-$30 copay for each therapy session with a therapist that is in the Healthfirst provider network. Copay rates vary, so you’ll need to consult your Summary of Benefits document to confirm what your copay will be. Some plans even offer therapy coverage at no cost to you, meaning you won’t have a copay for your sessions.
Most Healthfirst plans do not provide out-of-network benefits for therapy. This means that if you see a therapist that isn’t on the Healthfirst insurance panel, you’ll be responsible for paying the full session fee out of your own pocket, which can be $180-250 — or sometimes more. Working with an in-network therapist is a much more cost effective option if you’re looking to keep therapy within your budget.
What types of mental health conditions does Healthfirst cover?
Healthfirst strives to provide New Yorkers with comprehensive coverage so they can take care of their whole selves, including their mental and emotional well-being. That’s why they cover a wide range of mental health conditions, though to be eligible, you will need to receive a mental health diagnosis from your therapist. This guides Healthfirst as they reimburse your therapist through their billing processes.
Some common mental health conditions covered by Healthfirst include, but are not limited to:
If you’re uncomfortable with receiving a mental health diagnosis, you might consider paying privately for your sessions. This means that your therapist can work with you without needing to submit paperwork to a third party.
What types of therapy does Healthfirst cover?
As long as your therapist is licensed and uses a therapy approach that has clinical rigor behind it, Healthfirst will cover your therapy services. Healthfirst requires that therapists have the appropriate credentials to provide therapy in New York. They can be psychologists, psychiatrists, social workers, counselors, or any other mental health profession. They must also use an evidence-based therapy approach that is appropriate for the mental health diagnosis related to your case.
There are many types of therapy that are considered evidence-based, that is, those that have clinical evidence pointing towards their efficacy. Here are a few, though there are many more:
- Acceptance and Commitment Therapy (ACT)
- Cognitive Behavioral Therapy (CBT)
- Dialectical Behavioral Therapy (DBT)
- Eye Movement Desensitization and Reprocessing (EMDR)
- Mindfulness practices
- Child-parent psychotherapy
Often, therapists blend approaches to address all of your mental health concerns or goals. This is sometimes called “integrative” or “eclectic” therapy. As long as your therapist can report to Healthfirst that they’re using at least one appropriate therapy approach in their work with you, Healthfirst will continue to provide coverage for your sessions.
What types of therapy does Healthfirst NOT cover?
Healthfirst will not cover mental health services provided by therapists that do not have the appropriate professional credentials for New York State. Therapy approaches must also be based on clinical evidence, so modalities such as coaching, energy work like reiki healing, yoga therapy, or career counseling will not qualify for benefits from Healthfirst. Healthfirst will also not pay for acupuncture, even if it’s to treat a mental health condition.
That’s not to say that these approaches in therapy aren’t helpful for many people, and sometimes fully qualified therapists incorporate these approaches into their sessions as ancillary services. However, they cannot use these approaches as the sole method of treatment.
Does Healthfirst cover online therapy?
Yes, Healthfirst plans provide coverage for online sessions with your therapist, not just sessions conducted in your therapist’s office. They encourage their members to access care in the way that makes the most sense for them, and for many, that’s from the comfort of their homes.
When meeting with your therapist online, you’ll pay the same amount — the same copay — as you would if you were meeting with them in-person.
Does Healthfirst cover couples therapy?
Unfortunately, Healthfirst plans do not provide couples therapy benefits for their members. Often, this type of therapy session is not covered by healthcare insurance companies, as it’s difficult to prove as “medically necessary” and hard to track like they do with individual diagnoses. You may have to pay out-of-pocket if you want to work with a couples therapist, though many couples find couples therapy well worth the investment.
Do I need to see my primary doctor before starting therapy?
Healthfirst offers both HMO and EPO plans to their members, and depending on what type of plan you have, you may or may not need a referral from your primary doctor before starting therapy. If, on your Summary of Benefits document, you see that your plan is an HMO, then you will need a referral for therapy, as therapists are considered “specialist” providers. However, if your plan is an EPO plan, then you can see a specialist without a referral, meaning that you can start therapy as soon as you’re ready.