Understanding Your Insurance & Medicaid Options
Learn more about insurance, Medicaid, and other funding options for mental health services at Quality Youth Services. Coverage varies by plan and service, so understanding your benefits can help you prepare for treatment.
Mental Health Insurance & Medicaid
Paying for therapy can be confusing.
Quality Youth Services works with individuals and families throughout Ogden, Logan and Pleasant Grove, and many clients use insurance, Medicaid or another approved funding source to help pay for mental health services.
The important thing to understand is that coverage can vary by:
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Insurance company
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Individual plan
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Provider
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Location
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Service
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Diagnosis
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Authorization requirements
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Referral requirements
Because every plan is different, coverage should be verified before treatment begins whenever possible.
Does Insurance Cover Mental Health Therapy?
Often, yes.
Many health insurance plans include behavioral or mental health benefits.
Coverage may apply to services such as:
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Individual Therapy
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Child Therapy
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Teen Therapy
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Adult Therapy
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Family Therapy
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Group Therapy
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Mental Health Assessments
However, coverage depends on the specific insurance plan.
Does Medicaid Cover Mental Health Services?
Medicaid commonly provides behavioral health coverage for eligible members.
Coverage may include therapy and other mental health services when:
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The client is eligible
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The provider participates
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The service is covered
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Any required authorization is obtained
Not every provider, service or program should be assumed to be covered by every Medicaid plan.
Does QYS Accept Medicaid?
Quality Youth Services works with Medicaid-related services where applicable.
Because participation and coverage can vary by provider, program and location, contact QYS to confirm whether your specific Medicaid plan can be used for the service you need.
Does Insurance Cover Child Therapy?
Insurance may cover Child Therapy when the service is medically necessary and the provider participates with the plan.
Coverage can depend on:
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Diagnosis
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Provider network
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Deductible
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Copay
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Coinsurance
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Prior authorization
Parents should verify behavioral health benefits before the first appointment.
Does Insurance Cover Teen Therapy?
Yes, many plans cover Teen Therapy.
The same behavioral health coverage rules that apply to adults may also apply to teenagers, although some plans have specific requirements for dependents or minors.
Does Insurance Cover Adult Therapy?
Many insurance plans cover Adult Therapy.
Coverage may depend on whether the therapist is in network and whether the service meets the plan’s requirements.
Does Insurance Cover Family Therapy?
Sometimes.
Family Therapy may be covered when it is part of treatment for a covered mental health condition.
However, some plans may treat family counseling differently depending on:
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Who is identified as the client
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Diagnosis
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Treatment plan
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Billing rules
Coverage should be verified before treatment.
Does Insurance Cover Couples Counseling?
Not always.
Insurance generally covers medically necessary mental health treatment rather than relationship counseling by itself.
Couples Counseling may or may not be covered depending on:
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Diagnosis
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Plan rules
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Billing requirements
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Clinical purpose of treatment
Do not assume couples counseling is covered simply because the plan covers therapy.
Does Insurance Cover Group Therapy?
Many behavioral health plans cover Group Therapy when medically appropriate.
However, group availability, provider participation and coverage requirements vary.
Does Insurance Cover Telehealth Therapy?
Many insurance plans cover Telehealth Therapy, but coverage depends on the plan.
Important factors may include:
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Provider network status
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Client location
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Provider licensing
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Service type
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Telehealth benefits
Does Insurance Cover Mental Health Assessments?
Sometimes.
Coverage for Mental Health Assessments depends on:
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Assessment type
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Clinical purpose
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Diagnosis
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Provider
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Insurance plan
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Referral or authorization requirements
Not every assessment is treated the same by insurance.
Does Insurance Cover Comprehensive Mental Health Assessments?
A Comprehensive Mental Health Assessment may be covered when it is clinically appropriate and fits the insurance plan’s behavioral health benefits.
However, coverage should not be assumed for:
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Psychological testing
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Neuropsychological testing
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Forensic evaluations
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Court-specific evaluations
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Psychosexual evaluations
These may fall under different benefit rules or may not be covered.
Does Insurance Cover Sexual Behavior Assessments?
Coverage for Sexual Behavior Assessments varies.
If the assessment is required by:
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Court
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Probation
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Juvenile justice
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State agency
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Attorney
ask both QYS and the insurance company whether the requested assessment is covered.
Does Insurance Cover Court-Ordered Therapy?
Possibly.
A court order does not automatically make a service covered by insurance.
Coverage depends on whether:
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The service is medically necessary
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It is a covered benefit
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The provider is eligible
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Authorization requirements are satisfied
Does Insurance Cover Court-Ordered Assessments?
Not always.
Court-required or forensic assessments may be excluded from standard behavioral health benefits.
If a court has ordered a specific assessment, provide QYS with the exact written requirement and verify coverage before scheduling.
Does Insurance Cover DBT?
Insurance may cover therapy services associated with Dialectical Behavior Therapy, depending on:
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Provider
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Program structure
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Diagnosis
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Service type
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Insurance plan
Do not assume that every component of a DBT Program is automatically covered.
What Does “In Network” Mean?
An in-network provider has a contract with an insurance company or plan.
Using an in-network provider often means:
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Lower negotiated rates
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Lower copays
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Lower coinsurance
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Better coverage
However, exact benefits depend on your plan.
What Does “Out of Network” Mean?
An out-of-network provider does not have a contract with your insurance plan.
Depending on your plan:
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You may have no coverage
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You may have partial coverage
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You may pay more
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You may need to submit claims yourself
Some plans do not include out-of-network behavioral health benefits.
What Is a Copay?
A copay is a fixed amount you may pay for a covered visit.
For example, your plan might require a specific copay for each mental health appointment.
The actual amount depends on your insurance plan.
What Is a Deductible?
A deductible is the amount you may need to pay before your insurance begins paying certain covered expenses.
For example, if your plan has a behavioral health deductible, you may pay more for therapy until the deductible has been met.
What Is Coinsurance?
Coinsurance is a percentage of the allowed cost that you pay after any deductible requirements are met.
For example, the insurance company may pay part of the approved amount while you are responsible for the remaining percentage.
What Is Prior Authorization?
Some insurance plans require prior authorization before certain mental health services begin.
That means the insurer must approve the service before it is provided.
Services that may sometimes require authorization include:
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Assessments
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Certain programs
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Intensive services
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Specialized treatment
Do I Need a Referral From My Doctor?
It depends on the plan.
Some insurance plans allow clients to contact a mental health provider directly.
Others may require a referral from:
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Primary care provider
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Pediatrician
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Medical provider
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Behavioral health network
Check your individual plan.
How Do I Verify My Mental Health Benefits?
Call the member services number on the back of your insurance card.
Ask specifically about outpatient behavioral health or mental health benefits.
Useful questions include:
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Is Quality Youth Services in network?
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Is the specific therapist in network?
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What is my mental health copay?
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Do I have a deductible?
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Has my deductible been met?
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What is my coinsurance?
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Do I need prior authorization?
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Are telehealth visits covered?
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Is Family Therapy covered?
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Are Mental Health Assessments covered?
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Is there a limit on therapy visits?
Write down the representative’s name and the reference number for the call if one is provided.
Why Should I Verify the Specific Therapist?
Insurance networks may sometimes apply at the individual provider level.
That means a clinic may work with an insurer, but a particular clinician’s participation can still need confirmation.
Ask about the specific provider whenever possible.
Does an Insurance Quote Guarantee Payment?
No.
Insurance verification is not a guarantee that a claim will be paid.
Final payment can depend on:
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Eligibility on the date of service
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Diagnosis
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Medical necessity
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Coding
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Authorization
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Network status
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Plan rules
What if My Insurance Denies a Mental Health Claim?
Start by finding out why the claim was denied.
Possible reasons include:
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Deductible
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Provider network issue
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Missing authorization
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Non-covered service
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Eligibility issue
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Coding issue
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Plan exclusion
You may be able to contact the insurer for clarification or appeal options.
What if I Have Two Insurance Plans?
If a client has more than one insurance policy, the plans may use coordination of benefits rules.
One plan may be considered primary and the other secondary.
Provide both policies when scheduling.
Can I Use Medicaid as Secondary Insurance?
Sometimes.
The exact billing order depends on the coverage involved.
Provide QYS with all active insurance and Medicaid information so billing can be handled correctly.
Does Medicaid Always Mean Therapy Is Free?
No.
Coverage rules depend on the specific Medicaid program and service.
Do not assume that every service will have no client responsibility.
Does State Funding Pay for Therapy?
Sometimes.
Certain clients may receive services through a state contract or agency authorization.
Visit State Contracted Services for more information.
State funding should not be assumed unless authorization has been confirmed.
Insurance for Mental Health Services in Ogden
Quality Youth Services serves the greater Ogden area through our Harrisville office, located just minutes from Ogden.
Clients using insurance or Medicaid should confirm that:
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The provider participates
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The service is covered
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Any authorization is completed
Insurance for Mental Health Services in Logan
Our Logan location serves clients throughout Logan and Cache Valley.
Contact QYS and your insurance company to confirm coverage for the provider and service you need.
Insurance for Mental Health Services in Pleasant Grove
Our Pleasant Grove location serves clients throughout Pleasant Grove and surrounding Utah County communities.
Coverage varies by insurance plan, provider and treatment service.
Need Help Getting Started?
Insurance terminology can be difficult to understand.
Quality Youth Services can provide information about the services offered and help identify what billing information may be needed.
However, your insurance company is ultimately responsible for explaining the benefits under your individual plan.
If you are looking for mental health services in Ogden, Logan or Pleasant Grove, contact QYS with your insurance or Medicaid information and the service you are seeking.