When Insurance Won’t Pay for Therapy: Know Your Rights and How to Fight Back

I specialize in trauma-informed therapy because it can be remarkably effective in helping people make sense of difficult experiences and move forward with their lives. Unlike problems such as generalized sadness or worry, whose causes can sometimes be harder to pinpoint, trauma often involves one or more identifiable experiences that have profoundly affected how we see ourselves and the world. Once we begin to understand what happened, what it meant to us, and how it continues to affect our lives, we can work on addressing painful memories, triggers, and beliefs that may no longer serve us. The goal isn't necessarily to forget the past, but to reach a point where it no longer controls the present.

That said, trauma therapy can be time-consuming and therefore costly, lasting anywhere from a few weeks to years of weekly, sometimes twice-weekly, or every-other-week appointments. Some people who enter first response, law enforcement, and military professions also bring earlier trauma histories to their work, making treatment more complicated than it might be if we were addressing a single event, such as a shooting or suicide bombing.

For instance, sometimes we end up talking about themes that span many different stressful periods of your life, like a learned tendency to blame yourself for bad things that happen to you, or a habit of believing you can't do anything about major problems in your life.

The length of treatment and the need for continuity make affording therapy particularly important. Most major health insurance plans cover treatment for post-traumatic stress disorder (PTSD) and related conditions like depression and anxiety. Federal and state mental health parity laws generally require plans that cover mental health services to provide benefits comparable to those for physical health conditions, like a broken arm or diabetes. That doesn't mean every therapy session must be covered, but it does mean insurers generally cannot impose more restrictive limitations on mental health treatment than on comparable medical care.

Unfortunately, having insurance doesn't necessarily mean getting your therapy paid for.

According to a Kaiser Family Foundation (KFF) survey, 22% of insured adults who had used mental health services reported experiencing a denied insurance claim in the preceding year, although the survey could not determine whether those denials were specifically for mental health treatment. A separate KFF analysis of 2024 insurance claims found that insurers offering plans through HealthCare.gov denied approximately 19% of in-network claims.

Not all these denials were for mental health services, and some denied claims can eventually be corrected and paid. But the numbers illustrate a troubling reality: significant numbers of Americans face obstacles to getting healthcare covered, even when they have insurance.

It's no secret by now that health insurers, including private companies such as UnitedHealthcare and Blue Cross Blue Shield, can make it extraordinarily difficult for therapists and patients alike to figure out why claims aren't being paid. Public insurance programs, including Medicare and Medicaid, have their own complicated billing and administrative requirements.

You can unfortunately expect to spend minutes to hours on the phone waiting for a human being to answer, repeating the same information about your insurance ID, birth date, and dates of service over and over again. Often, you'll hear that the company cannot solve the problem because your provider needs to call, that your particular diagnosis isn't covered, or even that your coverage ended when you have reason to believe it remains active.

Some of these delays and inconsistent explanations may discourage people from fighting denied claims. Others may reflect sheer bureaucratic incompetence and unclear communication by companies to the populations they're supposed to serve.

I can tell you that if I had a dollar for every time I called to find out why a company wouldn't cover a meeting with a patient, I would be a much wealthier woman.

But one thing I've consistently noticed is that insurance companies sometimes respond more readily to patients than to the providers they're supposed to be paying. That's one reason I want to spend a few blog entries explaining your rights as a patient in therapy and what you can do if your insurance company refuses to pay for your sessions.

We'll start with what you're entitled to.

First, know your state's insurance laws.

I encourage you to familiarize yourself with laws in your state that require insurance companies to process claims within specified time frames.

In Maryland, for example, the state's Prompt Pay law generally requires insurers subject to the law to pay a properly submitted, or "clean," claim within 30 days of receiving it. If a claim is incomplete or disputed, the insurer generally must notify the provider of the specific problem or information needed within that period.

Importantly, these rules don't apply to every insurance arrangement. Medicare, federal employee health plans, and certain employer-funded plans, for example, operate under different requirements. Also, other national government healthcare plans like Tricare aren’t regulated at the state level. I’ll get to them in a later post.

Common reasons my patients and I hear for why companies won't pay include "incorrect modifier" or "subscriber information missing," among others.

The first might mean that a claim needs an additional letter or number to clarify something about the service, such as how it was provided. For instance, some insurers require specific coding to distinguish telehealth from in-person appointments. You can call your insurance company to ask what information or modifier is required and pass that along to your therapist.

In the second scenario, where subscriber information is missing, check that you gave your therapist the correct member ID and other information on your insurance card.

Sometimes, more complicated problems come up, like you and your provider not understanding the reason for a denial, or the company telling you something different every time you call.

Second, don't be afraid to challenge confusing or inconsistent explanations.

If you're frustrated or confused, don't automatically assume you've misunderstood something. Insurance companies are supposed to provide meaningful explanations for claim denials, and patients generally have rights to appeal adverse coverage decisions.

It can help to tell the person you speak with that you plan to take the matter further if the company cannot explain why your therapy isn't covered or what needs to happen to resolve the problem.

If you want to get specific, tell them you're considering contacting your state's insurance regulator.

Ask for the representative's name, a reference number for your call, and an explanation of the denial in writing. Keep track of when you called and what you were told. Write down the representative’s name and last initial and the call reference number, because you might be asked for this information later on.

If the company still cannot explain the problem or tell you what needs to happen next, it may be time to seek help from the authorities responsible for overseeing your insurance plan.

Third, file a complaint with your state insurance regulator.

In Maryland, the appropriate agency for many private insurance complaints is the Maryland Insurance Administration, or MIA. Its job includes investigating consumer complaints and determining whether insurers are complying with Maryland insurance laws.

You can go directly to the MIA's complaint page and follow the instructions to submit a complaint.

Fill out the information about your insurance company, your therapist, and the appointment dates in question as best you can.

In the section where you describe your complaint, explain what you've done to try to solve the problem directly with the company: when you called, what you were told, and why those explanations or proposed solutions were insufficient. Include relevant claim numbers, denial notices, and correspondence if you have them.

In my experience, the MIA has been mostly helpful, though sometimes it has taken multiple back-and-forth emails to get an issue clarified or resolved.

You can generally expect an investigation to take several weeks, although complicated cases may take longer. The agency may be able to obtain a clearer explanation from your insurer, identify a violation of insurance law, or help you understand why a particular service isn't covered.

One important qualification: the MIA doesn't regulate every health plan. Some employer-sponsored plans are governed by federal law instead. If you're covered by one of these plans, the U.S. Department of Labor's Employee Benefits Security Administration may be able to help. You can also ask your employer's benefits administrator which agency oversees your plan.

And remember that filing a regulatory complaint isn't necessarily the same as formally appealing a denial. If your insurer has given you an appeal deadline, don't let it pass while you're waiting for a complaint to be investigated.

Fourth, ask your elected representatives for help.

Calling your insurance company and filing a complaint with insurance regulators aren't your only options.

In several cases where these approaches haven't worked, I've contacted state elected officials for help. This has been particularly useful when dealing with complicated jurisdictional questions or insurers whose operations extend beyond Maryland.

Remember that your state senators and delegates are elected to serve their constituents. Many have staff members who help residents navigate problems involving government agencies, insurance coverage, and other essential services.

Google the name of your state and "find my representative" to locate your elected officials and their contact information. Call or email their offices, explain the problem, and ask whether someone can help you identify the appropriate agency or advocate for a resolution.

An elected official cannot force an insurance company to pay a claim that isn't covered, but their office may be able to help you get answers when you've reached a dead end.

Finally, remember that you're advocating for your own care.

These approaches have helped me advocate successfully on patients' behalf in many cases, and I hope they help you, too.

I also want to emphasize that advocating for payment is not simply about making sure your therapist gets compensated, although therapists, like other healthcare professionals, need to be paid for their work.

It's about protecting your access to treatment.

Trauma therapy often depends on trust, consistency, and the ability to work through difficult material over time. Interruptions caused by unresolved insurance problems can make that work harder, especially when you're already dealing with painful memories, anxiety, or other sources of stress.

You shouldn't have to become an insurance expert to get the mental healthcare you need. Nor should you feel that it's entirely your responsibility to solve billing problems that properly belong to your provider or insurer.

But knowing your rights, asking questions, and seeking help when something doesn't seem right can make a meaningful difference.

And if your therapist knows you're working together to resolve an insurance problem, that collaboration can help protect the continuity of your treatment.

The bottom line is this: a denied insurance claim doesn't necessarily mean the end of your coverage, and it certainly doesn't mean you should give up on getting the care you need.