Therapy Shouldn’t Be Confusing — Insurance Doesn’t Have to Be Either

Understanding your mental health benefits can help you focus less on paperwork and more on what truly matters: your healing.

Taking the first step toward therapy is courageous. Understanding your insurance shouldn’t be another obstacle along the way.

For many people, the biggest source of uncertainty isn’t deciding whether to seek support—it’s wondering what therapy will cost, whether insurance will cover it, or why they received a bill after an appointment. These questions are common, and you’re certainly not alone in asking them.

At According To Sykes, we believe that access to mental healthcare begins with transparency. Our goal is to make the financial side of therapy as clear and approachable as the clinical side, so you can feel confident from your very first appointment.

Let’s walk through a few of the basics.

Does Insurance Cover Therapy?

In many cases, yes—but every insurance plan is different.

Your behavioral health benefits may include coverage for:

• Individual therapy

• Couples counseling (when covered by your plan)

• Family therapy

• Telehealth services

Your out-of-pocket cost depends on several factors, including:

• Your annual deductible

• Copays or coinsurance

• Whether your provider is in-network

• Your individual insurance plan and benefits

Because every policy is unique, it’s always a good idea to verify your benefits before beginning treatment.

Five Insurance Terms Worth Knowing

Insurance language can feel like its own vocabulary. Here are five terms that can help you better understand your coverage.

Deductible

Your deductible is the amount you pay toward covered healthcare services before your insurance begins sharing the cost.

Example: If your deductible is $1,500 and you’ve paid $900 this year, you may still be responsible for additional therapy costs until the remaining deductible has been met.

Copay

A copay is a fixed amount you pay for each therapy session.

For example, your insurance may require a $30 or $50 copay while covering the remainder of the contracted session fee.

Coinsurance

Instead of a fixed copay, some insurance plans require you to pay a percentage of the visit.

For example, your insurance may pay 80% of the session while you’re responsible for the remaining 20%.

Out-of-Pocket Maximum

This is the most you’ll pay for covered healthcare services during your plan year. Once you reach that limit, many insurance plans cover eligible in-network services at 100% for the remainder of the year.

Explanation of Benefits (EOB)

An Explanation of Benefits, or EOB, isn’t a bill.

It’s simply a summary from your insurance company explaining:

• what your provider billed,

• what your insurance paid,

• and what, if anything, remains your responsibility.

Reviewing your EOBs regularly is one of the easiest ways to stay informed about your healthcare expenses.

Why Did I Receive a Bill Months Later?

One of the most common questions we hear is: “My insurance already paid. Why am I receiving a balance now?”

The answer often lies in how insurance companies process claims.

Claims aren’t always finalized immediately. Sometimes they are:

• delayed,

• reprocessed,

• adjusted,

• or even denied after an initial payment has already been made.

When this happens, insurance companies may determine that a different portion of the cost is the client’s responsibility. While this can certainly be frustrating, it doesn’t necessarily mean that anyone made a mistake — it often reflects the normal claims review process.

If you ever have questions about a balance, our team is always happy to walk through it with you.

Expanding Access to Mental Healthcare

The good news is that access to behavioral healthcare continues to improve.

Both federal and Illinois policymakers have strengthened protections that help ensure mental health services are treated more like physical healthcare. Illinois has also taken important steps to reduce administrative barriers for many outpatient behavioral health services, helping more people access care when they need it.

These changes reflect something we’ve believed all along: Mental health is healthcare, and everyone deserves access to compassionate, high-quality support.

Five Ways to Avoid Surprise Bills

While no insurance plan is exactly alike, a few simple habits can help make your experience much smoother:

✔️ Verify your mental health benefits before beginning therapy.

✔️ Review your Explanation of Benefits (EOB) after appointments.

✔️ Notify your provider if your insurance changes.

✔️ Keep a current payment method on file to prevent interruptions in care.

✔️ Don’t hesitate to ask questions — your therapy team is here to help.

A few minutes spent understanding your benefits today can prevent unnecessary stress later.

We’re Here to Help

Navigating insurance can feel overwhelming, but you don’t have to do it alone.

At According To Sykes, we believe that exceptional care extends beyond the therapy session. Our administrative team is committed to helping you understand your benefits, answer billing questions, and navigate the practical side of therapy with clarity and compassion.

Whether you’re seeking support for yourself, your relationship, your child, or your family, we’re here to make the process as seamless as possible — so you can focus on what matters most: healing, growth, and lasting well-being.

Ready to take the next step? Request a consultation through our website today and let us help connect you with the support that’s right for you. We look forward to walking alongside you on your journey toward healing.