If you’re considering EMDR therapy, you might be wondering: is EMDR covered by insurance? Most plans may have coverage for EMDR therapy, but coverage varies by provider and plan. Knowing what your insurance includes can help you plan for possible out-of-pocket costs.
Understanding your options for EMDR coverage gives you more control over your mental health care. Keep reading to learn what you can expect, typical costs, and other options if insurance doesn’t help.
Key Takeaways
- EMDR coverage depends on your insurance plan.
- Out-of-pocket costs may apply if not fully covered.
- Other therapy options are available if needed.
Insurance Coverage for EMDR Therapy
EMDR therapy may be covered by many health insurance plans, but coverage often depends on your provider, the reason for therapy, and where you live. Policies, approval steps, and payment responsibilities can vary a lot depending on the plan.
How Insurance Plans Cover EMDR
Many private insurance providers cover EMDR therapy sessions if it is considered medically necessary. This usually means you have a mental health diagnosis, such as PTSD, anxiety, or depression. Some plans might only cover EMDR for specific conditions like PTSD and not for broader uses.
Check if your insurance plan includes mental health benefits and whether EMDR treatment is listed as a covered. Some plans do not mention EMDR by name but cover “psychotherapy” or “talk therapy” provided by a licensed mental health provider.
Look for information in your plan details or member portal, or contact your insurance company to be sure. Be aware that coverage might limit the number of sessions or require progress reviews to keep paying for treatment.
Requirements for Insurance Approval
Insurance companies may require certain steps before they agree to pay for EMDR therapy. Pre-authorization is often needed. This means your therapist or doctor must provide paperwork to explain why EMDR is needed and show your diagnosis.
You might need to show that you have tried other types of therapy first, such as cognitive behavioral therapy (CBT), and that these did not help enough. This is called “step therapy” or “fail-first.” Your provider may need to submit notes or treatment plans to justify ongoing sessions.
Common requirements include:
- A referral from your primary care doctor
- A diagnosis of a covered condition
- Treatment provided by a licensed therapist
- Pre-approval or pre-authorization paperwork
If these steps are not followed, your insurance may deny coverage and you could have to pay for EMDR out of pocket.
In-Network Versus Out-of-Network Providers
Whether your therapist is “in-network” or “out-of-network” with your insurance makes a big difference in cost. In-network providers have agreed on payment rates with your insurance and usually cost you less. You may just owe a small copay or coinsurance amount per session.
Out-of-network providers usually cost more. You might need to pay the full fee up front and submit a claim to your insurer. You may get only partial reimbursement or none at all.
| Provider Type | You Pay | Paperwork |
|---|---|---|
| In-Network | Copay / coinsurance | Minimal; handled by provider |
| Out-of-Network | Upfront, then claim | More responsibility for you |
Always check your insurance network list or call your insurer to be sure your EMDR therapist is covered.
Coverage Differences: Private Insurance, Medicare, and Medicaid
Private insurance plans differ widely. Some may cover EMDR under mental health benefits, others may require higher deductibles or limit sessions. The type of policy, employer plan, and state can all affect what is covered.
Medicare usually covers some mental health treatments, but it may not always approve newer therapy methods like EMDR unless provided by specific types of licensed professionals. Check what your local Medicare plan says about EMDR.
Medicaid coverage for EMDR depends on the state. Some states include it as a covered behavioral health service, but others do not. If you have Medicaid, contact your state Medicaid office or managed care provider to ask about EMDR coverage and requirements.
Ask your provider or insurance plan for written details before starting treatment so you know what costs to expect.
Costs and Alternative Options for EMDR
EMDR therapy can come with costs that may not always be covered by insurance. If you are worried about paying for sessions, there are ways to lower what you pay or try other methods.
Typical EMDR Therapy Costs
Most EMDR therapists charge per session. On average, you can expect to pay $100 to $250 per session in the United States.
How much you pay depends on the therapist’s credentials, the clinic location, and the length of each session. Urban areas tend to have higher prices than rural ones.
Many therapists ask for payment after each visit. You may also need to pay for an initial intake session, which can sometimes cost more than regular appointments. Some clinics have package deals, but these are rare.
Typical Costs Table:
| Session Type | Estimated Cost (USD) |
|---|---|
| Intake Session | $125 – $300 |
| Regular Session | $100 – $250 |
| Package (5 visits) | $450 – $1,000 |
It is important to ask about all fees before starting treatment, so there are no surprises later.
Sliding Scale Fees and Community Resources
Some therapists offer sliding scale fees if you cannot afford the full price. This means the cost of each session is based on your income. You may need to show proof of your income, such as pay stubs or tax forms.
Ways to Find Lower-Cost EMDR:
- Ask therapists if they offer sliding scale prices.
- Check local mental health clinics.
- Look for nonprofit organizations that provide therapy services.
- Contact university counseling centers, as interns sometimes offer discounted sessions.
Some community centers or health departments also give free or lower-priced therapy. It helps to call around and ask about these resources, especially if you are on a tight budget.
Online and Self-Guided EMDR Options
Online EMDR therapy is growing in popularity. Licensed therapists provide EMDR sessions through secure video calls. Fees for online sessions are often similar to in-person visits, but some therapists may offer discounted rates.
Self-guided EMDR programs and apps exist, but they usually are not a full replacement for working with a trained professional. Prices for self-guided options vary, ranging from $30 to $150 for apps or courses.
If you choose an online or self-guided approach, check that the resource comes from a qualified source. For sensitive issues like trauma, professional guidance is usually safest, but these options can help if cost or travel is a concern.
Frequently Asked Questions
Insurance coverage for EMDR therapy depends on your provider, your plan, and the type of insurance you have. Some plans offer partial or full coverage, while others may not include it at all.
What types of insurance typically cover EMDR therapy?
Private insurance plans are more likely to cover EMDR therapy if it is considered a medically necessary mental health treatment. Many employer-sponsored plans also provide some mental health coverage that may include EMDR sessions. It’s important to check with your insurance company to confirm the details for your plan.
Does Blue Cross Blue Shield provide coverage for EMDR sessions?
Blue Cross Blue Shield may cover EMDR therapy, but coverage varies by state and specific plan. Some plans list EMDR as a covered service under behavioral or mental health benefits. You should call the member services number on your card or log in to your account for exact details.
Can I expect coverage for EMDR therapy if I am enrolled in Medicaid?
Medicaid coverage for EMDR therapy depends on the state where you live. Some states include EMDR as a covered mental health treatment, while others do not. Check with your state’s Medicaid office or review your benefits to see if EMDR is included.
Is EMDR therapy included in the Medicare benefits package?
Original Medicare does not specifically list EMDR therapy but covers mental health treatments provided by approved therapists. If your provider is Medicare-certified and bills the treatment as psychotherapy, you may get partial coverage. Always confirm with your therapist and Medicare before starting EMDR sessions.