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  • Christie Pearl, LMHC, LPC

FAQ's: Is EMDR therapy covered by insurance?: Everything you need to know

Updated: Jun 24

EMDR therapist writing on notepad in EMDR therapy session in Virginia

Dealing with your healthcare expenses can be overwhelming and confusing. Deductibles, out of pocket maximums, coinsurance, copayments, covered services, in network providers and out of network benefits - it's enough to make you want to tear your hair out!

And good luck trying to find straightforward and accurate information online. If you try to get your questions answered on Facebook or Reddit, what you will most likely hear are the worst case scenarios. Issues around money and the flaws in our healthcare system can elicit fear and anger for many people. Those perspectives, while valid, are probably not going to help you understand your benefits better. You're probably just going to feel upset and more confused!

Fortunately for you, prior to opening my private practice, I spent a decade working in managed care and healthcare policy roles. So, unlike most of my therapist colleagues, I have deep expertise in understanding how insurance companies work from the inside. My hope is that reading this will help you know how to maximize the use of your insurance benefits to pay for your EMDR therapy.

One caveat: I do not presume to know the policies for every insurance plan out there. What I am sharing here is general knowledge. It is always best to check the details with your particular plan.

Let's start with some basic facts about your insurance plan and paying for EMDR therapy

I know that sometimes it can feel like you are trapped by the healthcare system. More and more therapists are leaving insurance panels, especially therapists with a high level of expertise and experience. (I am one of those therapists. To learn more about why I chose to do so, you can read it here under the FAQ "Do you accept insurance?") So when you find a therapist who you think is perfect for you, and you find out that they are "private pay", meaning they don't take insurance, it can feel like a let down. All you want is to find a good therapist and do the work. And hitting barriers when it comes to accessing or paying for therapy can be frustrating to say the least.

Let's dive in.

Will my insurance plan pay for EMDR therapy?

Yes, most likely. But let's look at some fine print. It might surprise you to learn that even some therapists aren't clear on this.

Let's talk about in-network providers first, meaning the therapist has a contract with the insurance company to provide services to the members of that insurance plan. Most insurance plans cover outpatient therapy, regardless of what modality the therapist is using. Your plan likely doesn't care whether your therapist is using EMDR, CBT, DBT, ERP, Motivational Interviewing, Somatic Experiencing or any number of other therapeutic modalities. That is the HOW. The therapist is using a particular therapeutic approach in their work with you. Most insurance companies leave that up to the therapist. The insurance plan is interested in the WHAT. The WHAT is what the therapist is actually billing the insurance for: a 45-minute individual outpatient therapy session? A 50-minute family outpatient therapy session? A 60-minute group therapy session?

Insurance companies use what is called CPT codes. CPT stands for Current Procedural Terminology. It's a huge list of healthcare services with standardized terms and assigned codes that the American Medical Association maintains and insurance companies use. If your therapist sees you for a 60-minute individual therapy session, the therapist reports to the insurance company CPT code 90837. For a 45-minute individual session, they would report CPT code 90834. So the insurance company knows you and your therapist met for 60 or 45 minutes, respectively. They don't know what therapeutic approach your therapist was using.

Bottom line, there is no such thing as a CPT code for EMDR therapy. But if you are seeing an in-network EMDR therapist, and your insurance plan covers outpatient therapy, then your plan covers EMDR therapy.

So what will EMDR therapy with an in network provider cost me?

The answer is: it depends. On a lot of factors. Here are a few to consider.

If the EMDR therapist is in network with your insurance company, then most likely you will be required to pay a copayment and possibly coinsurance. Gone on the days of going to any medical provider and paying a $25 copay and calling it a day. If you've got a plan that still does that for you, then hold onto that policy with all your might! Most plans also have what is called a deductible and an out of pocket maximum. Let's define those terms now.

Deductible: the total amount you need to pay during that year before your plan will start paying for any services you receive; once you've met your deductible, then your plan will start covering more of your costs

Copayment: a fixed amount you pay for a healthcare service after you have paid your deductible

Coinsurance: a percentage you pay for a healthcare service after you have paid your deductible

Out of pocket maximum: the maximum amount you will be asked to pay out of pocket during that plan year; once you've met your out of pocket maximum, your plan will fully cover the cost of any services you receive after that for the rest of your plan year

Deductible amounts vary widely. Usually plans with higher deductibles have lower monthly premiums. These plans cost you less on a monthly basis. But if you require healthcare services during that plan year you will likely be paying out of pocket for most of it. For example, if your deductible is $8,000, then you will pay for the first $8,000 worth of healthcare costs before your plan starts sharing the cost with you. That means you are paying out of pocket for your visits to the doctor when you are sick, any appointments with specialists like OB/GYNs or dermatologists, the eye doctor, and, yes, your EMDR therapy. Even after you've met your deductible, you will still be paying copayments and coinsurance until you reach your out of pocket maximum.

Why am I explaining all this? Because I want you to be able to make informed choices.

Many people settle for an in-network therapist that they don't really want to see, but who is in network with their plan. They mistakenly believe that it will cost them less. And that isn't necessarily the case.

The moral of the story: check your plan details! Look at what your deductible is and what your out of pocket maximum is. Then you can decide if you want to spend your money on a therapist you really want who is out of network, or a therapist who you aren't as excited about but who is in network. Guess what? Depending on your plan, you might be paying the same thing either way.

Can I use my insurance for EMDR therapy when the EMDR therapist is out of network?

The short answer is: maybe.

Let's talk about out of network or "private pay" providers. This means that the EMDR therapist does not have any contract with the insurance company, so there is no relationship between that EMDR therapist and your insurance company.

If an EMDR therapist does not participate in insurance panels, then that means they have decided what their rates are going to be for their therapy services. The rates that any given therapist charges vary widely and usually account for the client population they work with, their geographical location, the extent of their experience and expertise, credentials they hold, and their income needs to support their family.

If you want to see an EMDR therapist who is out of network with your insurance plan, there is still a way you might be able to use your insurance to cover part of the cost.

The question is: Do you have out of network benefits included in your insurance policy?

Image of computer notebook and phone arranging for EMDR therapy in Virginia

What are out of network benefits?

When you picked your insurance plan - whether you get your insurance through an employer or purchase your own policy on a marketplace in the state where you live - you most likely received a packet of information about what is covered and what isn't. Usually you will get a summary - sometimes it looks like a chart - of various medical services. The chart will list how much you will pay in copays or coinsurance for each of those services or procedures after you meet your deductible. If you have out of network benefits, part of that chart - usually the left side - will list what you will pay for in network providers. The right side of the chart will show what you are expected to pay if you see an out of network provider.

Not all policies include out of network benefits. So if it isn't clear to you, then I suggest calling the main number on the back of your insurance card. The questions you want to ask are:

Does my policy allow for out of network providers?

If it does, what are my out of network benefits?

In other words, if your policy will cover services provided by out of network providers, how much will it cover? Some insurance plans will cover 80%. Some might cover 60%. And some won't cover any services unless they're from an in network provider.

How do out of network benefits work?

Unfortunately, if your policy does not allow out of network benefits, then there likely isn't a way to get your EMDR therapy covered or partially covered through your insurance. But there ARE a couple more ways you could potentially pay for it. More on that below.

Let's say you do have out of network benefits, and your policy will cover 60% of the cost.

First, you would meet with your EMDR therapist and you would pay out of pocket for your EMDR therapy sessions. Your EMDR therapist would collect payment from you according to whatever billing procedures they use in their practice. In my case, I charge my clients' credit cards or FSA cards on the day of their session with me. Other EMDR therapists might send you an invoice on a weekly or even monthly basis - that is all up to the individual therapist.

Next, the EMDR therapist would provide you with what is known as a "superbill." A superbill is different from a receipt, an invoice, or a statement. Receipts, invoices and statements usually contain only the date(s) of your EMDR therapy session(s), what you owe or what you paid, and maybe the name of the services you received, i.e. "Psychotherapy for 60 min" or "Individual therapy, 45 min". A superbill however, contains much more information than that. It has the EMDR therapist's tax ID information, your policy information, your social security number and date of birth, your diagnosis, the POS (place of service) and those CPT codes that we talked about earlier. This is the information that most insurance companies require in order to process an out of network payment. In my practice, superbills are generated automatically on the 5th of every month. Clients receive an email letting them know they can log into their client portal and download their superbill.

So you got your superbill. Now what? You would submit that superbill to your insurance company in whatever way they ask you to. It might be faxing it, it might be uploading it to an online portal for your plan, or old fashioned snail mail. Your insurance company will tell you how they want to receive it.

Once they receive it, if the superbill has all the required information, then the insurance company will process it and send you your reimbursement. So you are paying up front for your EMDR therapy, and getting paid back later for part of it.

What if I don't have out of network benefits but I really want to see a particular EMDR therapist?

For all of you who don't have out of network benefits, but you really want to see an EMDR therapist with deep expertise and experience, here are a couple more options for you.

First, don't forget about your FSA (flexible spending account) and your HSA (health savings account)! If you have funds set aside for healthcare expenses, most likely you can use them to see your preferred EMDR therapist. In my practice, if it looks like a credit card and acts like a credit card, then it's a credit card! My clients can enter whatever card they want into their client portal.

Image of saving for EMDR therapy with piggy bank on top of calculator

Second, and this one might seem obvious to you, but you can always save up the money. I have had clients who really wanted to work with me, but who didn't have out of network benefits and didn't necessarily have the disposable income ready to cover the cost. So they saved up the funds and were able to work with me when they were ready.

We all get to decide how we prioritize our spending. These clients made temporary sacrifices in their spending to save up for EMDR therapy with me. Those temporary sacrifices yielded permanent results in their healing journeys.

Summing up the facts about paying for EMDR therapy

Whew! That might have been more facts than you wanted LOL. But I'd rather you have too much than not enough. If this was too much to digest all at once, you can come back later and revisit it.

To recap what we learned:

  • Most likely your insurance plan covers EMDR therapy if outpatient therapy is a covered service under your plan. Your insurance company only cares about what CPT code the therapist bills for - not the modality that they are using.

  • The cost of EMDR therapy with an in network provider varies widely and depends largely on how high your deductible is. And, depending on your plan, the cost for in network and out of network could be very similar.

  • How to use your out of network benefits, if you have them.

  • Be sure to use your FSA or HSA funds, or save up the funds the old fashioned way in your savings account.

The healthcare system in our country can be convoluted and confusing. I hope that by reading this blog you now have a better understanding of how to navigate your insurance policy and use it to get the support you need.

Image of EMDR therapist and EMDR consultant in VA 23226
About the Author

Christie Pearl is a Licensed Professional Counselor in Virginia and a Licensed Mental Health Counselor in Massachusetts. She is a Certified EMDR Therapist and EMDRIA Approved Consultant, and she specializes in EMDR therapy for adults who have experienced complex trauma. In her almost two decades of experience in the mental health field, she has held leadership positions in community mental health, insurance and managed care, healthcare policy and private practice. Throughout her experience, Christie has developed expertise in the intersection of healthcare policy and clinical practice.


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