Will My Insurance Pay for EMDR Therapy?
EMDR, or Eye Movement Desensitization and Reprocessing therapy, is often covered by insurance, but coverage can vary depending on the providers and plans. Many major insurance companies do cover EMDR therapy because it’s recognized as an evidence-based mental health treatment for post-traumatic stress disorder (PTSD) and other mental health conditions by organizations like the American Psychological Association and the Department of Veterans Affairs. Coverage typically applies when EMDR is provided by licensed mental health professionals for conditions with clear medical necessity, particularly trauma-related disorders for which EMDR treatment has strong clinical support.
However, several factors can affect insurance coverage, including your specific insurance plan, whether your EMDR therapist is in-network, and your diagnosis. Some insurance plans may limit the number of sessions covered or require prior authorization. Many patients find it beneficial to verify coverage by contacting their insurance company directly, specifically asking about EMDR coverage for their condition, any session limitations, and out-of-pocket costs. If insurance coverage is limited, many EMDR therapists offer sliding scale fees or payment plans to make treatment more accessible.
Some plans may cover online therapy services for EMDR, whereas others may require in-person attendance for EMDR sessions. Individual sessions of EMDR (Eye Movement Desensitization and Reprocessing) therapy are the standard, regardless of whether it is in-person or online therapy.
Please contact us to discuss your specific insurance coverage for EMDR therapy at Balanced Mind of New York.
Insurance Terms Explained
What Does “In-Network” Insurance Provider Mean?
An in-network insurance provider is a healthcare professional, hospital, or medical facility that has negotiated a contract with your health insurance company. These providers agree to offer services at reduced rates to the insurance company’s members. When you visit an in-network provider for EMDR therapy sessions, you typically pay less out-of-pocket because your insurance covers a larger portion of the cost. Insurance companies create these networks to control costs and ensure quality care for their members, while providers join networks to gain access to the insurer’s customer base.
The Eye Movement Desensitization and Reprocessing (EMDR) therapists at Balanced Mind of New York are pleased to be an in-network provider for clients covered by Aetna insurance plans.
What Does “Out-of-Network” Insurance Provider Mean?
An out-of-network provider is a healthcare professional or facility that hasn’t contracted with your insurance company. These providers haven’t agreed to the discounted rates that in-network providers accept, meaning they can charge their full rates for services. When you visit an out-of-network EMDR therapist, your insurance typically covers a smaller percentage of the cost, if anything at all, resulting in higher out-of-pocket expenses. Some insurance plans, particularly HMOs, may not cover out-of-network care except in emergencies, while others like PPOs offer partial coverage but with higher deductibles and coinsurance rates.
For out-of-network providers, Balanced Mind of New York will provide superbills for reimbursement. We will contact your insurance company to confirm your eligibility and out-of-network benefits, including the insurance reimbursement rate for each EMDR session. We will also guide you through the process of sending superbills to your insurance. Insurance typically reimburses 50-80% of the EMDR therapy fee, but please note that out-of-network benefits vary based on the provider.
What is a Co-Pay?
A co-pay (or copayment) is a fixed amount you pay for a covered healthcare service, such as Eye Movement Desensitization and Reprocessing (EMDR) therapy, at the time of care. For example, you might pay $25 or $50 each time you visit your EMDR therapist. Co-pays are typically due before you receive the mental health service and are separate from your deductible. The specific co-pay amounts vary by insurance plan and type of service. Even after you’ve met your annual deductible, you usually continue to pay co-pays until you reach your out-of-pocket maximum for the year.
What is Co-Insurance?
Co-insurance is the percentage of costs you pay for covered healthcare services after you’ve paid your deductible. Unlike a co-pay, which is a fixed amount, co-insurance is calculated as a percentage of the total allowed amount for the service. For example, if your co-insurance is 20%, you pay 20% of the allowed cost for the service while your insurance covers the remaining 80%. So, for a $100 service, you would pay $20 if your co-insurance is 20%. Co-insurance applies until you reach your plan’s out-of-pocket maximum, at which point your insurance typically covers 100% of allowed costs for the remainder of the plan year.
What Types of Mental Health Concerns May Be Covered by Insurance?
Eye Movement Desensitization and Reprocessing (EMDR) therapy effectively treats a wide range of mental health conditions, primarily those with a traumatic component. Originally developed for PTSD, EMDR has strong clinical support for treating trauma-related disorders, including complex trauma and developmental trauma. Its applications have expanded to include anxiety disorders, depression (particularly when trauma-linked), and addiction issues with underlying trauma. EMDR can also address grief, complicated bereavement, and dissociative disorders.
Some practitioners use modified EMDR therapy protocols for pain management, eating disorders, and performance anxiety. The therapy is particularly valuable for conditions where traumatic memories or negative beliefs contribute to current symptoms, as it helps process distressing memories and integrate them into a more adaptive perspective, reducing their emotional impact and associated symptoms.
Post-Traumatic Stress Disorder (PTSD)
PTSD has the strongest evidence base for Eye Movement Desensitization and Reprocessing (EMDR) treatment and is most consistently covered by insurance. EMDR was originally developed for trauma treatment and has extensive research supporting its effectiveness for alleviating PTSD symptoms, making it a first-line treatment that insurers typically approve. EMDR sessions focus on using bilateral stimulation, such as eye movements, to reprocess traumatic experiences with the goal of reducing or eliminating distressing symptoms related to those memories.
Anxiety Disorders
Anxiety disorders refers to category of mental health issues and includes generalized anxiety, phobias, and panic disorder. These conditions are often covered when EMDR is used as part of a comprehensive treatment plan. Insurance companies generally recognize EMDR as an effective intervention for anxiety-related conditions, especially when they have a clear traumatic component. EMDR helps reduce anxiety symptoms by using bilateral stimulation to reprocess traumatic memories, allowing you to heal from past wounds and improve your overall emotional well-being.
Depression
EMDR treatment for depression is often covered by insurers, particularly when it co-occurs with trauma or anxiety. When the depression is linked to traumatic events or distressing past experiences, or when other forms of treatment have been unsuccessful at improving mental health symptoms, the insurer may be more likely to provide coverage for EMDR therapy.
Complex Trauma and Dissociative Disorders
Childhood trauma, abuse histories, and dissociative identity disorder, are increasingly being covered for EMDR therapy as research continues to demonstrate its effectiveness for these conditions. By reprocessing the distressing memories and traumatic events via bilateral stimulation, the memories can become less painful, leading to enhanced emotional regulation and more adaptive coping skills along the healing journey.
Other Conditions
Other mental health concerns that may be covered include adjustment disorders, grief/complicated bereavement, substance abuse or addiction (especially when trauma-related), spousal betrayal, and some somatic (physical) symptom disorders. Coverage for these conditions varies more significantly between insurance carriers and plans.
For any diagnosis, insurance coverage typically requires that the EMDR treatment be deemed “medically necessary” and that EMDR be provided by a licensed mental health professional who has received specialized training in the technique. Some insurers may require documentation of previous treatment attempts or specific justification for why EMDR therapy is the appropriate mental health treatment for your particular condition before they will agree to cover EMDR therapy.
How Much Does EMDR Therapy Cost?
EMDR therapy costs vary widely based on several factors:
Without insurance, a standard EMDR therapy session typically ranges from $100 to $250 per session, with costs in major metropolitan areas often reaching the higher end of this range. Some specialized or highly experienced therapists may charge $300 or more per session. The national average cost is approximately $150-175 per session.
EMDR treatment isn’t usually a one-time intervention. A complete course of EMDR therapy generally requires 6-12 sessions, though more complex trauma may require additional sessions. This brings the total cost for a complete treatment to approximately $900-$3,000 or more.
With insurance coverage, your out-of-pocket costs for EMDR therapy may be significantly reduced to just a copay (typically $20-50 per session) or coinsurance percentage after meeting your deductible. However, this depends entirely on your specific insurance plan and whether your EMDR therapist is in-network.
Some community mental health centers, training institutes, or therapists in training may offer EMDR therapy sessions at reduced rates, sometimes as low as $50-75 per session. Additionally, many therapists offer sliding scale fees based on financial need, which can reduce the EMDR therapy cost to make treatment more accessible.
How Do I Pay for My EMDR Therapy Sessions at Balanced Mind of New York?
At Balanced Mind of New York, we offer multiple payment options to fit your needs and budget.
In-Network Insurance Provider:
Balanced Mind is proud to be an in-network provider for clients covered by Aetna, Cigna, Oscar, and Oxford insurance plans. Through these plans, we are pleased to offer EMDR therapy in individual virtual and in-person formats.
Out-of-Network Insurance Provider:
For all other insurances, we provide superbills for reimbursement. We will contact your insurance company to confirm your eligibility and benefits, including the reimbursement rate for each session. We will also guide you through the process of sending superbills to your insurance.
If you have an out-of-network plan, any reimbursements will be sent directly to you from your insurance carrier. Insurance typically reimburses 50-80% of the fee, but note that each policy is different.
Self-Payment Options:
If no insurance coverage is available, clients may choose to pay for services out of their own pocket. If you need to pay out of pocket, we offer a sliding scale as part of our commitment to providing affordable care.
We accept Visa, MasterCard, Discover, American Express, and HSA/FSA cards.
Contact Us to Learn More About EMDR Therapy
To learn more about payment options for EMDR, please contact Balanced Mind of New York to schedule an appointment.
