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How to use your insurance for therapy in Texas

Insurance can bring the cost of therapy or treatment way down, if you know what to ask. Here's what the words on your plan mean, what to ask before your first visit, how Medicaid, CHIP and Medicare work in Texas, and your rights when you pay yourself.

Updated October 25, 2026. General information, not medical, legal or insurance advice.

If you need help now: call 911 in an emergency. In a mental health or substance use crisis, call or text 988, any time. SAMHSA's National Helpline, 1-800-662-4357, is free, confidential and open 24/7 for treatment referrals.

The words that decide your cost

Deductible: what you pay each year for covered care before your plan starts to pay.
Copay: a flat amount you pay per visit, usually at the visit.
Coinsurance: a percentage of the cost you pay after the deductible, such as 20%.
Allowed amount: the most your plan pays for a service. Coinsurance is figured on this, not on the provider's full fee.
Out-of-pocket maximum: the most you'll pay for covered in-network care in a plan year. It doesn't count your monthly premiums or out-of-network care.

An example, with made-up numbers: your plan's allowed amount for a session is $100 and you have 20% coinsurance. Until you meet your deductible, you pay $100 a session. After that, you pay $20.

In network or out of network

An in-network provider has a contract with your plan and can't bill you more than the plan's agreed rate for covered services. An out-of-network provider has no contract, so you'll usually pay more, and they can bill you the difference (balance billing).

HMO and EPO plans generally cover no out-of-network care, except emergencies.
PPO plans let you see out-of-network providers without a referral, for a higher share of the cost.

Network status is per plan, not per insurance company, so confirm with both the provider and your plan. Federal surprise billing protections mainly cover emergencies and certain care at in-network hospitals and surgery centers, so they usually don't help when you choose an out-of-network therapist.

What to ask when you call your plan

Call the member services number on your card (or the behavioral health number, if there's a separate one) and ask:

Is this provider in network for my plan, for mental health (or substance use) care?
What are my deductible and out-of-pocket maximum, and how much have I met this year?
What do I pay per therapy session: a copay or coinsurance? Does the deductible apply first?
Do I need a referral or prior authorization for therapy, psychiatry, IOP or PHP?
Are video visits covered the same way as office visits?
Is there a limit on the number of sessions?
Do I have out-of-network benefits? If so, what's the out-of-network deductible, and what share do you pay?

Write down the date, the rep's name and the call reference number, in case a claim is denied.

Behavioral health carve-outs

Some plans hand the mental health and substance use benefit to a separate company. This is called a carve-out. That company has its own network and approves care, so ask it, not the medical plan, about networks and approvals. The clue is usually a separate "behavioral health" number on your card. Parity law allows carve-outs, but the benefit can't be managed more strictly than medical care.

Texas Medicaid (STAR) and CHIP

Most Texans with Medicaid get it through a health plan they choose (managed care). Medicaid and CHIP both cover screening and treatment for mental health conditions and substance use disorders. The programs are:

STAR: the largest, mainly for children, pregnant women, and parents and caretakers with limited income.
STAR+PLUS: adults with disabilities and people 65 and older, including many who also have Medicare.
STAR Kids: children and young adults 20 and younger with disabilities.
STAR Health: children and youth in foster care and some young adults who were in foster care.
CHIP: children in families that earn too much for Medicaid but can't afford private insurance.

Texas Medicaid's substance use benefits include outpatient counseling, withdrawal care, residential treatment and medication-assisted treatment. Use providers in your health plan's network (call the number on your plan card). A provider who takes your Medicaid generally can't charge you for covered services.

Apply at YourTexasBenefits.com or by calling 2-1-1. If you don't qualify for Medicaid, the state checks CHIP for your children automatically.
Change plans: Medicaid members can change at any time through the Texas Enrollment Broker, 800-964-2777. CHIP members can change in their first 90 days, then mainly at renewal.
Trouble getting care: call your plan first, then the HHS Ombudsman: 866-566-8989 for managed care, or 800-252-8154 for behavioral health.

Medicare

Medicare Part B covers outpatient mental health care, including individual and group therapy, family counseling when its main purpose is your treatment, psychiatric evaluations and medication management. It covers visits with:

psychiatrists and other doctors, clinical psychologists, clinical social workers (LCSWs in Texas), clinical nurse specialists, nurse practitioners and physician assistants;
since January 1, 2024, marriage and family therapists and mental health counselors, a group that includes licensed professional counselors. Addiction counselors qualify only if they meet all of Medicare's counselor requirements, including a master's degree.

After the yearly Part B deductible ($283 in 2026), you generally pay 20% of the Medicare-approved amount, if the provider accepts assignment (takes Medicare's amount as full payment). One who doesn't can charge you more, and Medicare pays nothing to a provider who has opted out, so you'd pay the full fee. Ask before your first visit.

Medicare covers mental health visits by video, including at home; a rule requiring an in-person visit has been delayed until after December 31, 2027. Medicare Advantage plans have their own networks; call yours like a private plan. For free Medicare help in Texas, call HICAP at 800-252-9240.

The parity law

Under the federal Mental Health Parity and Addiction Equity Act, if a plan covers mental health and substance use care, its deductibles, copays, coinsurance, visit limits and rules like prior authorization can't be stricter than for medical and surgical care. It applies to plans from employers with more than 50 workers, to individual and Marketplace plans, and, through the Affordable Care Act, to many small-employer plans. Texas has its own parity law for state-regulated plans, and Texas Medicaid and CHIP plans must follow parity.

You can ask your plan for the medical necessity criteria it uses and the specific reason for any denial. A plan can still deny a service as not covered or not medically necessary, as long as it judges medical care the same way.

Who regulates your plan? Look at your card. If it says "TDI" or "DOI", the Texas Department of Insurance regulates it. If it doesn't, it's probably a self-funded plan, where your employer pays the claims, and the U.S. Department of Labor oversees it.

Superbills and out-of-network claims

If your therapist is out of network, you may still get some money back. Many give you a superbill: a detailed receipt that usually lists your diagnosis and service codes, the dates and fees, and the provider's license and NPI (national provider ID) number. You pay the therapist, send the superbill to your plan with its claim form, and the plan pays you its share.

Ask first whether you have out-of-network benefits (many HMO and EPO plans don't), what the out-of-network deductible is, and how long you have to file.
The plan pays based on its allowed amount, not the therapist's fee.
Medicare pays nothing for care from a provider who has opted out.

An example, with made-up numbers: a session costs $150, your plan's allowed amount is $100, you've met your out-of-network deductible, and your out-of-network coinsurance is 40%. The plan pays you $60, so the session costs you $90.

Paying yourself: sliding scale and Good Faith Estimates

Ways to lower the cost:

Sliding scale: many providers set fees by income. Ask when you call.
Community health centers serve you whether or not you have insurance, with fees based on income and family size. Find one at findahealthcenter.hrsa.gov.
Local mental health authorities offer crisis services and care to Texans without insurance. For substance use, HHSC's OSAR (Outreach, Screening, Assessment and Referral) programs are the starting point for state-funded treatment. Call 2-1-1 to find both.
Your employer's Employee Assistance Program (EAP), if it has one, is free and confidential.

Your right to a Good Faith Estimate. Under the federal No Surprises Act, if you're uninsured or not using insurance, providers must give you a written estimate of expected charges when you schedule at least 3 business days ahead, or whenever you ask. For ongoing therapy, one estimate can cover up to 12 months. If your bill comes in at least $400 over the estimate, you can dispute it within 120 calendar days of the bill date. This right doesn't apply to Medicare, Medicaid, CHIP, TRICARE or VA care, which have their own billing protections.

If your plan says no

Ask for the denial and the reason in writing.
File an internal appeal with the plan, usually within 180 days.
If it still says no, ask for an external review by an independent reviewer (faster for urgent care).

Free help: the Texas Department of Insurance Help Line, 800-252-3439, for plans it regulates; the U.S. Department of Labor's benefits advisors, 1-866-444-3272, for employer plans; and the HHS Ombudsman for behavioral health, 800-252-8154.

Ready to look? Search Texas providers by insurance, then confirm with your plan. Choosing a program? Read IOP vs PHP vs weekly therapy. Choosing a person? Read how to choose a therapist in Texas. Every listing shows when its license was checked (how listings work), and more plain-language guides are on our guides page.

Questions people ask

Do I need a diagnosis to use insurance for therapy?

Usually, yes. Insurance pays for care that's medically necessary, so a claim includes a diagnosis code. If you'd rather not have one on file with your plan, you can pay yourself.

Can a therapist charge me for a missed session?

With private insurance or self-pay, it depends on the policy you agreed to, so ask before your first visit. Texas Medicaid providers can't bill Medicaid members for missed appointments.

What if I can't find an in-network therapist?

Ask your plan to help you find someone taking new clients, or to approve an out-of-network provider at in-network cost, and write down who you talked to. If not, call the Texas Department of Insurance Help Line or, for Medicaid, the HHS Ombudsman.