PacificSource for Therapy

PacificSource is a health insurance company located in the Pacific Northwest. They provide comprehensive healthcare plans for individuals, small groups, and large groups, as well as Medicare plans and community plans. They believe that mental health and well-being is a major component of overall health, which is why they offer their members mental health benefits.

Does PacificSource cover therapy?

Yes, PacificSource provides coverage for behavioral and mental health services for both in-network and out-of-network therapists. How much of your therapy costs PacificSource covers, however, depends on the plan that you have. Many of the PacificSource plans cover a portion of the therapy session fee but not all of it. Many PacificSource participants are required to pay a copay or coinsurance for each therapy session.

How do I check if my PacificSource plan covers therapy?

To check if your PacificSource plan covers therapy, read through your Summary of Benefits document. Therapy sessions are included in the item titled “Office visits” and then look under “Specialist.”  This item will tell you the amount of the session fee for which you’ll be responsible.

You can find your Summary of Benefits document within your PacificSource online portal, or from your company’s HR team if you receive your plan through your employer. If you’re not able to locate this document, find the customer service number on the back of your insurance card. The customer service agent will point you in the right direction of where to find out information about your mental health benefits.

How much does therapy cost with the PacificSource plan?

Across the majority of PacificSource plans, expect to pay a copay of $40-100 per visit with your in-network therapist. This will tend to be less expensive than working with an out-of-network therapist, as you will need to pay 50% of the session fee — and this only kicks in after you’ve met your deductible. Once you’ve met your deductible, you’ll pay half of what your therapist charges per session. If they charge $250 per session, you’ll be responsible for $125 out-of-pocket.

Because there are many different plans offered by PacificSource, you’ll need to find out the exact details of how much therapy costs for your specific plan before you start therapy. This will mean that you aren’t surprised by anything and can focus solely on your mental health.

What types of mental health conditions does PacificSource cover?

PacificSource mental health benefits include treatment for the following mental health conditions, as well as many more:

• Depression
• Anxiety
• Alcohol abuse
• Drug abuse
• Grief and loss
• Eating disorders
• Obsessive compulsive disorder (OCD)

When you start therapy with an PacificSource in-network therapist, they will provide you with a diagnosis that will guide and monitor your insurance coverage. If you would prefer that your therapist doesn’t disclose your diagnosis with PacificSource, you can consider paying privately so that your mental health care stays between you and your therapist.

What types of therapy does PacificSource cover?

PacificSource covers many different therapy approaches and modalities, particularly those that have clinical evidence that points towards its efficacy. This means that there is research that shows that the therapy approach is helpful in improving individuals’ mental health. Here are some examples of evidence-based therapy modalities:

• Cognitive Behavioral Therapy (CBT)
• Dialectical Behavioral Therapy (DBT)
• Eye Movement Desensitization and Reprocessing (EMDR)
• Psychodynamic therapy
• Acceptance and Commitment Therapy (ACT)

Many therapists blend their approaches while meeting with clients, which is called eclectic or integrative therapy. As long as the therapist meets all of the PacificSource requirements, they are still eligible for coverage.

What types of therapy does PacificSource NOT cover?

If a therapy approach is not evidence-based — that is, it lacks empirical research backing its ability to improve people’s mental health — PacificSource will not provide coverage.

Life coaching and career coaching are examples of non-evidence-based therapy approaches, as they are less based on the mental health literature and more on goal-setting and achievement. While many therapists incorporate life coaching or career coaching into their work, they cannot solely rely on these approaches to be eligible for reimbursement. PacificSource also does not cover holistic approaches to treatment such as aromatherapy, massage therapy, or nutritional therapy. They also do not cover hypnosis, ketamine, and psychedelic treatments, even if the purpose of this treatment is for a mental health condition.

Does PacificSource cover online therapy?

Yes, PacificSource covers online therapy — and they’ll cover 100% of the costs when you see your in-network therapist online. This is through Teladoc, an online platform that provides members with access to online appointments with primary care, urgent care, and mental health providers. If you see your in-network or out-of-network therapist outside of this app, however, you’ll pay the same amount you would if you met with them in-person.

Does PacificSource cover couples therapy?

Most healthcare insurance companies do not provide benefits for couples therapy. This is generally because it’s not possible to provide a singular diagnosis for more than one person, and without that diagnosis, the insurance company isn’t able to monitor progress or provide reimbursement.

However, there are many ways to make couples sessions more affordable so you can heal and grow your relationship.

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

Depending on your PacificSource health insurance plan, you may need to receive a referral from your primary care doctor before you begin seeing your therapist. For all PacificSource plans that are HMO, you will need to visit your primary care physician to receive such a referral. You may do this through the Teladoc app provided by PacificSource, which is a convenient and cost-effective way to get started.

If you have a PPO PacificSource plan, then you won’t need a referral before you begin therapy — and you can start your search for a great fitting therapist as soon as you’re ready!