Key Takeaways 

• Most insurance plans cover child therapy sessions to some extent.

• The amount covered depends on your specific insurance plan and your child's needs.

• If you don't have insurance, there are alternatives to consider, including paying out of pocket for therapy.

Are you considering therapy for your child but wondering how you will cover the cost? 

If you have health insurance, it may cover therapy. However, the extent of this coverage varies widely based on the individual plan and your child's needs.

Before scheduling child therapy, it's important to understand what is and isn’t covered. In this article, we’ll go over in more detail what you can expect when it comes to child therapy and insurance coverage.

Insurance Coverage for Child Therapy

Most health insurance plans include coverage for counseling and other behavioral health services. 

However, the extent of coverage varies. While some plans cover counseling, others may require you to pay out-of-pocket. You may also have a deductible that requires that you pay for therapy services before insurance coverage kicks in. 

It's important to review your policy to find out the specifics and determine if there are any exclusions or limitations to your coverage.

Types of Health Insurance Plans

There are several different types of health insurance plans, including:

• Employer-sponsored plans - These are private health insurance plans that employers offer. These plans vary greatly in terms of the benefits and features.

• Health insurance marketplace - This is a health insurance exchange sponsored by the government for those who aren’t able to get insurance through their employer. These plans cover therapy and behavioral health services, but the specifics vary depending on the plan.

• Medicaid - A government-funded program that provides health insurance coverage for those who qualify. Medicaid coverage depends on the individual state but covers therapy and behavioral health care.

Most of the above plans cover therapy services, but the number of sessions and types of therapy may be limited. While insurance coverage can make child therapy more financially accessible, your provider may not cover everything.

Common Mental Health Coverage Terms

Understanding insurance coverage can be tricky. Therefore, it is helpful to familiarize yourself with common terms associated with mental health coverage.

• Copay - A copay is a fixed amount you pay upfront for covered services. The amount depends on your provider, the service, and your insurance plan.

• Deductible - A deductible is how much you must pay before insurance covers the rest of your services.

• Out-of-pocket - This term refers to the total amount (including insurance, copays, and your deductible) you pay out-of-pocket for health care.

What Types of Child Therapy Are Typically Covered?

Several types of child therapy are typically covered through insurance.

Some focus on managing distorted thinking patterns. Other services provide specialized treatment for children with underlying diagnoses like ADHD and autism.

Individual Therapy

Individual therapy for children can help them cope with issues like depression, anxiety, or behavioral problems.

It focuses on setting goals, processing the past, and learning positive ways to manage thoughts and behaviors at home and school.

Family Therapy 

The goal of family therapy is to solve problems, improve communication, and build a stronger family unit. Family members can address specific issues in an emotionally safe environment during sessions.

Specialized Therapies

Some children may benefit from specialized therapies that focus on specific diagnoses.

For example, applied behavior analysis (ABA) is a specialized therapy that helps children with autism spectrum disorder develop new skills and improve their quality of life.

Young children may benefit from play therapy, which uses games and activities to help them address challenges like anxiety or trauma.

Virtual Therapy

Virtual therapy is often covered by health insurance, but coverage depends on the provider, plan, and state regulations. 

Many major insurance companies, including Blue Cross Blue Shield, Aetna, Cigna, and UnitedHealthcare, offer teletherapy coverage, especially as demand for remote mental health services has increased since the COVID-19 pandemic. 

However, factors such as plan type, in-network vs. out-of-network providers, and medical necessity requirements can impact coverage. Some insurers require a mental health diagnosis for reimbursement, and state laws may also influence whether virtual therapy is covered at the same rate as in-person sessions. 

To determine eligibility, it’s best to check directly with the insurance provider or use platforms like Emora Health, which help connect parents with therapists for children who accept their insurance. Find a virtual therapist for your child today.

Factors That Affect Insurance Coverage for Child Therapy

Insurance coverage for mental health has improved over the years. However, there are still limitations.

The amount you pay is impacted by several factors, including the provider you choose and if there are pre-authorization requirements.

In-Network vs. Out-of-Network Providers

Most plans have their own networks of preferred providers.

For therapy to be covered, you will need to choose a provider who is in your network. An out-of-network provider is someone who is not part of your insurance provider list, and you may need to pay more to see them.

Medical Necessity and Pre-Authorization Requirements

Insurance companies often require documentation from a healthcare professional stating that counseling is medically necessary.

Pre-authorization requirements refer to the specific criteria you must meet for your health insurance to cover services.

Diagnosis Requirements 

Many insurance plans require a formal mental health diagnosis for virtual therapy to be covered.

This means a licensed therapist or psychiatrist must assess the client and determine that therapy is medically necessary for treating a specific condition, such as anxiety, depression, or PTSD. 

Without a diagnosis, some insurers may not cover sessions or may limit the number of covered appointments. 

Additionally, certain plans may only approve treatment for conditions listed in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders).

If a diagnosis is required, clients should discuss this with their therapist and check with their insurance provider to understand how it affects coverage.

How To Check Your Insurance Policy

While most insurance companies often cover child mental health services like counseling, not all of them do. 

Some only cover certain types of care. Knowing how to check your policy can help you determine what is and is not covered. This can help you better plan for therapy.

Review Your Benefits Summary

Carefully review your policy's benefits summary to understand what is covered. Look for specific information about behavioral and mental health.

You can also log onto your insurance account online to check coverage and costs.

Call Your Insurance Provider for Details

If you are unsure whether your insurance covers therapy, call your provider directly and speak to an agent. They should be able to clarify what services are covered and any amounts you may need to pay out of pocket.

What To Do if Insurance Doesn't Cover Child Therapy 

Insurance coverage for child therapy varies by policy and provider. If you have limited or no coverage, there are still other alternatives to consider so you can get help for your child.

Pay Out-of-Pocket

If your insurance company does not cover behavioral health services, you have a high deductible, or your therapist is out of network, you might consider paying out-of-pocket.

Some online platforms, like Emora Health, offer affordable child therapy for those who pay out of pocket.

Look for Sliding Scale Fees and Financial Aid Programs

Many therapists provide their services on a sliding scale. This means the cost of your child's sessions is adjusted according to your income. Financial aid programs are also available to help pay for child therapy. 

For example, the Kosair for Kids Foundation offers financial assistance to help pay for therapy and other medical services for those who qualify.

This can make counseling much more accessible for families who would otherwise not be able to afford it.

Consider Alternative Therapy Options

Nonprofit organizations and free counseling services offered through community clinics can help you afford therapy otherwise not covered by your insurance. 

However, there may be limited availability and specific eligibility criteria to be aware of. Make sure to research the services available and whether there are any potential costs or requirements to qualify.

The sooner you get your child into counseling, the sooner they can get the help they need.

Whether you have insurance or have to pay out-of-pocket, you can use Emora Health to find the right therapist that will help your child thrive.            

Takeaway

Child therapy can be an important part of a child’s mental and emotional well-being, and many insurance plans offer coverage for these services. 

However, coverage varies depending on factors such as the type of insurance plan, in-network provider requirements, state regulations, and whether a formal diagnosis is needed.

Some policies may cover specific types of therapy while limiting others, so it's necessary for parents to review their plan details and verify coverage with their provider. 

Understanding these factors can help families make informed decisions about their child’s mental health care and ensure they receive the support they need without unexpected financial burdens.

Find a Virtual Therapist for Your Child with Emora Health

Emora Health connects families with licensed therapists who specialize in ADHD and evidence-based treatments like behavioral therapy, CBT, and social skills training.

Emora Health emphasizes a holistic approach, addressing not only the child's ADHD symptoms but also the well-being of the entire family. By offering resources, counseling, and education, they help create a supportive environment where children can thrive.

Get started today.

Sources

1. Healthcare.gov (2025). Mental health & substance abuse coverage. Retrieved from: https://www.healthcare.gov/coverage/mental-health-substance-abuse-coverage