Kaiser Permanente PPO for Therapy | Zencare Guide — Zencare

Kaiser Permanente PPO for Therapy

Kaiser Permanente PPO is a health insurance plan offered by Kaiser Permanente, a major managed health care consortium with reach across the country that strongly believes in the importance of whole-person care and enhanced mental healthcare access. Kaiser Permanente offers HMO, EPO, and PPO health insurance plans. With the Kaiser PPO plan, you get access to the large PHCS Kaiser Permanente provider network — which has over 750,000 providers! — or you can see any licensed provider without needing a referral first. The network includes thousands of excellent therapists ready to help you with your mental health journey.

Does Kaiser Permanente PPO cover therapy?

Yes. Kaiser PPO offers coverage for mental health services including therapy. Kaiser Permanente PPO has an extensive network of therapists to choose from, giving you the opportunity to find the therapist that’s just right for you. If you choose to see a therapist outside of the Kaiser Permanente PPO’s in-network provider list, you’ll still receive some coverage — which makes seeing a therapist budget-friendly no matter the therapist’s provider status.

There are four PPO plans offered by Kaiser (Bronze, Silver, Gold, Platinum) that vary in their therapy benefits; however, all include mental health coverage in their plans. It’s important to understand the specific details of your Kaiser Permanente PPO plan before beginning therapy so you have an accurate picture of what it will cost you.

How do I check if my Kaiser Permanente PPO plan covers therapy?

To determine if your Kaiser PPO plan covers therapy, visit your Summary and Benefits document through your online Kaiser Permanente PPO account portal. Within this document, you’ll find “outpatient services” under the behavioral and mental health section — this is where your coverage information will be.

Example Kaiser Permanente PPO Summary of Benefits, with Outpatient Mental Health section highlighted

If you cannot locate your Summary and Benefits document or still have questions about your mental health benefits, call the customer service number on the back of your insurance card. Through this hotline, you’ll speak with a Kaiser Permanente PPO customer service representative who can assist you.

How much does therapy cost with my Kaiser Permanente PPO plan?

While therapy costs will vary based on which plan you have, expect to pay a copayment of between $15 - $65 for each therapy visit with an in-network therapist. If you see an out-of-network therapist, you’ll be responsible for a coinsurance of 30% - 100% per visit. The coinsurance rate describes the amount of the session fee for which you’re responsible. This means that it’s often much more cost-effective to see a therapist that’s in-network with your Kaiser Permanente PPO plan.

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 Kaiser Permanente PPO cover?

Kaiser Permanente PPO believes that mental health is vital for overall wellness. Because of that belief, they provide coverage for a wide range of mental health conditions. These conditions include:

When you start therapy, your therapist will designate a diagnosis for your condition or goals. They’ll share this diagnosis with Kaiser Permanente PPO to ensure coverage. If you would prefer that your therapist doesn’t disclose your diagnosis with Kaiser Permanente PPO, consider your out-of-network options. This way, your mental health care stays between you and your therapist — not the insurance company and anyone who has access to your insurance account information.

What types of therapy does Kaiser Permanente PPO cover?

Kaiser Permanente PPO reimburses for many different evidence-based therapy approaches and modalities. This includes but is not limited to:

Often, therapists use blended methods as they individualize treatment for each client. As long as the therapist is professionally credentialed and provides appropriate therapeutic services, Kaiser Permanente PPO will cover therapy sessions.

What types of therapy does Kaiser Permanente PPO NOT cover?

If a therapy approach is not evidence-based — that is, it lacks empirical research backing its efficacy — Kaiser Permanente PPO will not cover therapy costs.

This includes life coaching and career coaching, as these disciplines are less based on the mental health literature and more on goal-setting and achievement. Kaiser Permanente PPO does not cover holistic approaches to treatment such as aromatherapy, massage therapy, acupuncture, or nutritional therapy. They also do not cover ketamine and psychedelic treatments, even if the purpose of this treatment is for a mental health condition.

However, Kaiser Permanente does offer an acupuncture plan, so if you’re interested in receiving this service as a supplement to your mental health treatment, you may find this plan appealing.

Does Kaiser Permanente PPO cover online therapy?

Yes, Kaiser Permanente PPO covers online therapy. Many clients prefer to see their therapist regularly online, rather than in-person — whether it’s for convenience or accessibility. Therapists in-network with Kaiser Permanente PPO must use a secure video platform for each therapy session, which ensures that each client’s information remains safe. The costs and coverage for therapy services will remain the same, no matter if the client sees their therapist online or in-person.

Does Kaiser Permanente PPO cover couples therapy?

Kaiser Permanente PPO does not cover couples therapy — however, it does cover family therapy, which may be relevant for some clients. Many health insurance companies do not offer couples therapy benefits for their members. This may be because it’s difficult to provide a diagnosis for a couple, rather than an individual, and this diagnosis is a requirement for reimbursement.

There are still ways to access couples counseling even if your insurance does not cover it: here are five ways to pay for couples counseling.

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

No, you do not need to see your primary care physician before starting therapy with your Kaiser Permanente PPO plan. Having a PPO plan not only lowers many of your out-of-pocket expenses but also gives you the opportunity to search for a high-quality therapist as soon as you’re ready.