Meritain Health for Therapy
Meritain Health is a subsidiary of Aetna Health, which means that it’s part of one of the largest health insurance companies in the country. Rather than provide the insurance themselves, Meritain Health is a third-party administrator (TPA), which means that they provide administrative support for employers who want to self-fund their employee’s health coverage. However, you will use your Meritain Health plan just like an insurance plan, as you’ll receive coverage for various services — including therapy.
Does Meritain Health cover therapy?
Yes, most plans under Meritain Health cover therapy. Because Meritain Health plans generally come from your employer, the amount of coverage you receive from your Meritain Health plan differs based on your location, plan, and employer — so it’s important to understand what mental health services your specific plan offers. Some employers decide that they want to offer more therapy coverage for their employees, while others abide by standard insurance rates.
How do I check if my Meritain Health plan covers therapy?
To check if your Meritain Health plan covers therapy, read through your Summary of Benefits document or the employee handbook given to you from your employer during onboarding or your benefits election period. These documents will share with you the coverage rates for your Meritain Health plan.
Look for the section that’s called “Mental health/Behavioral health and substance abuse.” This section generally has two parts: in-patient and outpatient services. Therapy will fall under outpatient services. You’ll see that within outpatient service, if your plan offers coverage, there are both in-network and out-of-network providers. Working with an in-network therapist will likely be less expensive for you than working with one that is out-of-network.
If you still aren’t sure whether your Meritain Health plan covers therapy services, a great next step is to call Meritain Health and ask them about your specific plan. If you already have an insurance card, find Meritain Health’s phone number on the back. Once on the phone, ask them about your therapy benefits, including out-of-pocket cost per session.
How much does therapy cost with my Meritain plan?
You can expect to pay around $50-$150 out-of-pocket per therapy session with your Meritain plan, but each plan is different, so there is no set cost per session. For some Meritain Health plans, you’ll have to pay a copay of around $30 per session plus a coinsurance rate, which is the portion of the session fee that you’re responsible for. This means that if you see a therapist who has a higher cost-per-session, you’ll have to pay more out-of-pocket. For some out-of-network providers, you might have to pay as much as 60% of the session fee, which can range from $120-$250 or more.
If you want to limit your out-of-pocket spending, try to find a therapist that is in-network with Meritain Health, as their services will have more coverage than others. For both in-network and out-of-network therapists, please note that you may be limited to a certain number of visits per year, which may impact your plans for using your insurance.
What types of mental health conditions does Meritain Health cover?
Meritain Health covers a wide range of diagnosable mental health conditions. To qualify to use your therapy benefits, your therapist may need to assign you a diagnosis as part of the paperwork for your claims.
Some common mental health conditions covered by Meritain Health include:
What types of therapy does Meritain Health cover?
Meritain Health will provide coverage for therapy as long as your therapist is using a therapy approach that has clinical rigor behind it and is appropriate to your mental health condition or situation. There are many different types of therapy, each one with its own approach to supporting the client. Therapists often offer multiple approaches simultaneously — this is called an integrative or eclectic approach. Some common therapy approaches include:
- Acceptance and Commitment Therapy (ACT)
- Cognitive Behavioral Therapy (CBT)
- Dialectical Behavioral Therapy (DBT)
- Eye Movement Desensitization and Reprocessing (EMDR)
- Mindfulness practices
- Child-parent psychotherapy
Meritain Health requests that therapists report what modality they’re using when working with their members, so your therapist may list several approaches within your claim paperwork.
What types of therapy does Meritain Health NOT cover?
Meritain Health will not cover mental health services provided by therapists who are not fully licensed practitioners of their geographic jurisdiction. All therapy services that are eligible for coverage must be provided by a trained, credentialed therapist. This means that those offering life coaching, energy work, yoga therapy, or career counseling might not qualify for benefits from Meritain Health. While many credentialed therapists incorporate elements of the above listed in their sessions, providers who do not have an active license to practice are ineligible.
Does Meritain Health cover online therapy?
Yes, Meritain Health covers online therapy — in fact, they actively encourage it. Meritain Health understands that online therapy offers its members more accessible mental health services, therefore it offers the same amount of coverage for online therapy as they do for in-person therapy. This means that the same copay and coinsurance rates apply for each session.
Does Meritain Health cover couples therapy?
Some Meritain Health plans may cover couples therapy, however typically couples therapy is not covered by insurance. If your Meritain Health plan doesn’t cover couples therapy, you may need to pay the session fees out-of-pocket — which can be upwards of $150 per session.
Your Summary of Benefits document will detail out whether or not couples therapy is eligible for coverage. You can also call Meritain Health to confirm whether or not they’ll cover your couples therapy sessions, and if so, how much.
Do I need to see my primary doctor before starting therapy?
For the Meritain Health plans that are PPOs, you will not need a referral from your primary doctor before starting therapy. As with other speciality providers, referrals aren’t necessary to access your benefits. However, if your Meritain Health plan is an HMO, you will be required to get a referral from your primary doctor before you start working with a therapist. You may need to update this referral each year by visiting your primary doctor and requesting another referral.