Neighborhood Health Plan of Rhode Island | Mental Health Insurance Coverage — Zencare

Neighborhood Health Plan of Rhode Island for Therapy

Neighborhood Health Plan of Rhode Island is a not-for-profit health insurance company that provides healthcare coverage for over 150,000 Rhode Island residents each year. They offer private and Medicaid health care plans under an HMO policy. Neighborhood Health Plan of Rhode Island strongly believes in comprehensive care for all members of the community, which is why they provide mental health benefits with each of their plans. They partner with Optum for behavioral health services, including Optum’s expansive therapist network.

Does the Neighborhood Health Plan of RI cover therapy?

Yes, the Neighborhood Health Plan of RI covers therapy services. However, the amount of the therapy cost they cover depends on your unique health insurance plan. Because the Neighborhood Health Plan of RI provides multiple health insurance plans, your coverage will vary depending on the plan with which you’re enrolled. All of their health insurance plans include mental health benefits, however how much coverage they offer varies based on the specifics of the plan.

Neighborhood Health Plan of RI contracts with Optum, a provider of mental health insurance services. Optum’s therapist network includes thousands of therapists across the country.

How do I check if my Neighborhood Health Plan of RI plan covers therapy?

To check if your Neighborhood Health Plan of RI health insurance plan covers therapy services, look over to your Summary and Benefits document. Within this document, you’ll find the different rates of coverage — including copayment or coinsurance amounts — for each type of service available. Look for “outpatient mental health services” to see your coverage for therapy. You may also need to locate your Optum summary and benefits document, as Neighborhood Health Plan of RI partners with Optum for behavioral health coverage.

Example Optum Summary of Benefits, with specialist outpatient visit 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 Neighborhood Health Plan of RI customer service department will share with you the coverage available to you through your plan.

How much does therapy cost with the Neighborhood Health Plan of RI plan?

Expect to pay a copayment of between $40-100 each time you see your therapist with the Neighborhood Health Plan of RI. You may instead have a coinsurance rate of between 10-40%, which means that you’re responsible for that percentage of the total therapy costs.Your out-of-pocket costs for therapy services will depend on your specific health insurance plan. Because Neighborhood Health Plan of RI and Optum offer multiple health insurance plans, be sure to check the details of your plan before starting therapy to understand your financial responsibilities.

It’s important to pay attention to whether or not your therapist is in-network with Optum. Many Optum plans offer out-of-network therapy coverage, however not all of them do. Neighborhood Health Plan of RI encourages their members to work directly with Optum regarding their mental health coverage, so calling Optum’s customer service line is an effective way to learn about your future therapy costs.

What types of mental health conditions does Neighborhood Health Plan of RI cover?

Neighborhood Health Plan of RI health insurance covers the treatment for many mental health conditions. To reimburse therapists or clients, Neighborhood Health Plan of RI requires that the client receive a diagnosis from their therapist. This diagnosis guides treatment and insurance coverage.

Examples of eligible mental health conditions include:

There are many more diagnosable — and reimbursable — mental health conditions, all of which Neighborhood Health Plan of RI.

What types of therapy does Neighborhood Health Plan of RI cover?

Neighborhood Health Plan of RI covers many different types of therapy. As long as the therapist provides an evidence-based, clinically rigorous therapy modality that is appropriate for the given diagnosis, Neighborhood Health Plan of RI will provide coverage.

These evidence-based therapy modalities include:

Many therapists blend their approaches, using more than one treatment modality — even in one session! As long as the therapist has professional credentials and they base their services upon a clinical diagnosis, they are eligible for reimbursement.

What types of therapy does Neighborhood Health Plan of RI NOT cover?

Neighborhood Health Plan of RI does not cover life coaching, career counseling, or holistic treatment modalities like aromatherapy, massage therapy, or non-medically required acupuncture. It also does not cover energy work such as reiki healing. Neighborhood Health Plan of RI also does not cover hypnosis, ketamine, or psychedelic treatments, even if in aid of a mental health condition.

Does Neighborhood Health Plan of RI cover online therapy?

Yes, Neighborhood Health Plan of RI offers coverage for online therapy. This opens the doors for many clients who aren’t able to physically attend therapy sessions each week. Neighborhood Health Plan of RI’s mental health partner, Optum, also offers many online mental health resources such as education, activities, and FAQs.

Your coverage for therapy costs will remain the same, whether you visit your therapy in-person or online. This includes copayments and coinsurance rates.

Does Neighborhood Health Plan of RI cover couples therapy?

Whether Neighborhood Health Plan of RI covers couples therapy depends on the specific plan. Generally, health insurance plans do not cover couples therapy. This is partially because there cannot be a diagnosis to base the reimbursement upon. However, some Neighborhood Health Plan of RI plans may provide coverage at the same or differing rates as individual therapy. To see if yours does, visit your Summary and Benefits document. Again, because Neighborhood Health Plan of RI contracts with Optum for behavioral health services, you may need to check the information about your Optum benefits.

However, many couples still benefit from seeing a therapist together. If your Anthem Blue Cross and Blue Shield health insurance plan does not include a couples counseling benefit, there may be ways to decrease the cost of couples counseling, such as sliding scale.

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

Because Neighborhood Health Plan of RI plans are HMO health insurance plans, you will need to get a referral from your primary care physician before you start seeing a therapist. This means that you’ll likely need to first schedule a visit with your primary care physician to get this referral. However, attaining a referral can be a quick process and not be a barrier to starting your mental health journey. Once you receive the referral, you’re ready to start the search for a therapist just right for you!