Understanding Your Coverage Shouldn’t Be This Hard—Let’s Break It Down
You’ve made the brave choice to seek mental health treatment. Now comes the hard part—figuring out your insurance benefits.
Does your plan cover therapy? What about TMS or Spravato®? Are pre-approvals required? How much will you actually owe?
At Bella Vida TMS, we guide patients across Phoenix, Gilbert, Scottsdale, and Glendale through the insurance maze every day. Whether you’re new to mental health care or trying to understand your options for more advanced treatments, this blog will help you confidently navigate your coverage.
Step 1: Know What Kind of Plan You Have
Before you call or log in to your insurer’s portal, get clear on your plan type:
- HMO (Health Maintenance Organization): Requires referrals and in-network providers
- PPO (Preferred Provider Organization): More flexibility, but higher out-of-pocket costs
- EPO (Exclusive Provider Organization): In-network only, but no referrals needed
- Medicare / Medicare Advantage: Government-funded; may require special documentation
- Medicaid / AHCCCS (in Arizona): Managed through regional health plans like Mercy Care or Care1st
Each type of plan handles mental health benefits—and approvals—differently.
Step 2: Ask the Right Questions
When you call your insurance company (or have Bella Vida TMS call for you), here’s what to ask:
✅ General Coverage
- Does my plan cover mental health services?
- Is there a separate deductible for behavioral health?
- What is my copay or coinsurance per session?
✅ Specific Treatments
- Is Transcranial Magnetic Stimulation (TMS) covered?
- Is Spravato® (esketamine nasal spray) covered for treatment-resistant depression?
- Is talk therapy or medication management included?
- Are ketamine infusions or other off-label treatments eligible for reimbursement?
✅ Authorization & Limits
- Do I need pre-authorization?
- Is a referral required from a primary care doctor?
- Are there any session limits per year?
Step 3: Understand Key Terms
Here’s a quick cheat sheet of insurance lingo you’ll hear:
- Deductible: The amount you must pay before your plan starts covering care
- Copay: A flat fee you pay for each visit (e.g., $25 per therapy session)
- Coinsurance: A percentage you pay after hitting your deductible (e.g., 20%)
- Out-of-pocket max: The most you’ll have to pay in a year before your plan covers 100%
- Prior Authorization: Approval needed before a treatment like TMS begins
- Medical Necessity: Proof your provider gives to show a treatment is needed
Bella Vida TMS will explain these in plain language and help you understand what applies to your treatment.
Step 4: Leverage Your Provider’s Help
Don’t do this alone. At Bella Vida TMS, we:
- Verify your benefits before you begin
- Handle prior authorizations and all insurance paperwork
- Submit Letters of Medical Necessity
- Advocate for Single Case Agreements or appeals if you’re denied
- Help you understand what’s covered and what’s not—before you commit
Step 5: What to Do If You’re Denied
If your insurance company says “no,” you still have options:
- File an appeal with our team’s help
- Request a peer-to-peer review between your doctor and theirs
- Explore cash-pay options, sliding-scale pricing, or CareCredit financing
- Check if TMS or Spravato® is covered under a different diagnosis, like depression + PTSD or OCD
- Use an HSA/FSA account to cover costs with pre-tax dollars
We’ve helped hundreds of patients overturn denials and access care—without delay.
Common Mistakes to Avoid
❌ Don’t assume all mental health services are covered the same
❌ Don’t wait until after treatment to ask about costs
❌ Don’t rely only on the insurance rep—get documentation in writing
❌ Don’t skip seeking care if you’re unsure about coverage—we can help you find a path forward
How to Check Mental Health Insurance Benefits
Navigating your mental health benefits can feel overwhelming—but you’re not alone. With the right questions, support, and knowledge, you can unlock powerful treatments like TMS, Spravato®, and therapy without fear or confusion.
At Bella Vida TMS, we make it our mission to help you access the care you need—with insurance support, transparent pricing, and real advocacy.
📚 References
- HealthCare.gov – Understanding Health Insurance Terms
https://www.healthcare.gov/blog/understand-your-health-insurance-terms/ - National Institute of Mental Health (NIMH) – Mental Health Treatment Overview
https://www.nimh.nih.gov/health/topics - Centers for Medicare & Medicaid Services (CMS) – TMS Coverage and Behavioral Health Services
https://www.cms.gov - U.S. Department of Labor – Mental Health Parity and Addiction Equity Act (MHPAEA)
https://www.dol.gov/agencies/ebsa/laws-and-regulations/laws/mental-health-and-substance-use-disorder-parity - CareCredit – Mental Health Financing Options
https://www.carecredit.com/wellness/mental-health/
