Does Insurance Cover EMDR Therapy?
Usually, yes. Most insurance plans cover EMDR the same way they cover any other type of therapy. It gets billed as psychotherapy. Your insurance company doesn’t see “EMDR” on the claim. They just see that you had a therapy session.
If your plan covers outpatient mental health services, it probably covers EMDR.
How to Check Your Coverage
Call the number on the back of your insurance card and ask about outpatient mental health benefits. Here’s what you want to find out.
Do I have coverage for outpatient psychotherapy. What is my copay or coinsurance for therapy sessions. Do I need a referral from my primary care doctor. Is there a limit on how many sessions are covered per year. Do I need prior authorization before starting treatment.
Your answers will depend on your specific plan. Some plans have a flat copay per session, like $30 or $50. Others make you pay a percentage of the cost after your deductible. Some require you to use therapists in their network. Others let you see anyone and reimburse you later.
In Network vs Out of Network
If a therapist is in network with your insurance, they have a contract with your insurance company. You pay your copay, the therapist bills insurance directly, and that’s it.
If a therapist is out of network, you typically pay the full session fee upfront. Then you can submit a claim to your insurance for reimbursement. How much you get back depends on your out of network benefits.
Out of network reimbursement usually works like this. You pay the therapist. They give you a receipt called a superbill with all the billing codes. You submit that to your insurance. After you meet your out of network deductible, insurance pays you back a percentage of the cost.
Some plans reimburse 50 to 80 percent. Some have such high deductibles that it barely matters. And some plans, especially HMOs, have no out of network benefits at all.
EMDR Sessions Can Be Longer
One thing that affects coverage is session length. Standard therapy sessions run 45 to 53 minutes. But EMDR often works better with longer sessions, anywhere from 60 to 90 minutes.
Insurance typically covers standard length sessions. If your therapist does extended sessions, you might pay extra for the additional time, or the therapist might bill it differently. Ask your therapist how they handle billing for longer EMDR sessions before you start.
Why Some People Choose Not to Use Insurance
Even when insurance covers EMDR, some people decide to pay out of pocket anyway. There are a few reasons for this.
Insurance requires a mental health diagnosis. To bill insurance, your therapist has to give you a diagnosis like PTSD, anxiety, or depression. That diagnosis becomes part of your medical record. It can potentially affect things like life insurance rates or certain job applications. Some people prefer to keep their mental health treatment completely private.
Insurance companies can request your records. When you use insurance, you’re giving your insurance company access to information about your treatment. They can ask for notes, treatment plans, and session summaries. Paying privately keeps everything between you and your therapist.
Insurance limits your therapist options. If you want to use in network benefits, you’re limited to therapists who take your plan. The best EMDR therapist for your situation might not be in your network. Paying out of pocket lets you choose anyone.
Many EMDR specialists don’t take insurance. Therapists who specialize in EMDR often work in private practice and don’t participate in insurance networks. The reimbursement rates are low, the paperwork is heavy, and insurance doesn’t pay well for the longer sessions that make EMDR most effective.
What to Ask Before You Book
When you’re looking for an EMDR therapist, get the payment stuff sorted early. Ask whether they take your insurance. If they don’t, ask whether they provide superbills for out of network reimbursement. Find out what they charge per session and whether they offer sliding scale. Knowing all this before your first session saves you from surprises.
We offer in-person EMDR therapy at our Philadelphia and Haddonfield offices, with online sessions available for clients anywhere in Pennsylvania and New Jersey.