Does Cigna cover therapy in Arizona? What you will actually pay

Yes, in most cases. Cigna plans sold to employers and on the marketplace cover outpatient mental health care, and We accept Aetna, Cigna, Carelon Behavioral Health and Curative at PATH, for individual therapy, couples therapy, psychiatric evaluations and medication management. What you pay per visit is not a PATH number; it is written into your plan, and it is one of three kinds of number. This article shows you how to find yours.

One thing we will not do is quote a dollar copay for Cigna. There is no single figure: a Cigna plan from one employer and a Cigna plan from another can treat the same therapy hour differently, and marketplace plans differ again. Anyone who tells you "Cigna therapy costs X" is guessing.

Start with your card

A Cigna card carries a member ID, a group number and a plan name, and on many plans the copays for an office visit and a specialist visit are printed on the front. If a specialist copay is there, that is usually the one that applies to a therapy session.

Turn the card over. Some Cigna cards list a separate phone number for behavioral health or mental health. If yours does, that is the number to call with the questions below, because the people on that line have the mental health benefits in front of them.

The three numbers that decide your cost

Every plan answers three questions, and the answers set your price per visit.

1. Is there a copay for an outpatient mental health visit? A copay is a fixed amount, the same every visit. If the answer is yes, your cost per session is that amount.
2. If not, what is the coinsurance? Coinsurance is a percentage of the price the plan has agreed with the provider. At 20 percent you pay a fifth of that price and the plan pays the rest.
3. Does the deductible apply first, and how much of it is left? A deductible is the amount you pay in full each plan year before the plan starts paying. If it applies to therapy, you pay the full agreed price per session until it is met, and the copay or coinsurance applies after that.

Here is why the third question matters most. Suppose your plan has a copay for office visits and the deductible does not apply to them. Then every therapy session costs you that copay, from the first visit. Now suppose instead that your plan applies the deductible first. Then your first several sessions cost the full agreed price, and the copay only starts once the deductible is met. Same plan name, very different first month. The plan documents say which of the two you have.

Video visits

If you plan to be seen by video, ask whether telehealth visits are covered on the same terms as office visits. Most plans now cover them the same way, and PATH charges the same rate for both, but it is a one-sentence question worth asking.

How to check in ten minutes

• The card. Copays on the front, phone numbers on the back.
• The myCigna portal or app. Sign in, open your benefits, and look for behavioral health or mental health, outpatient. You are looking for a copay or a coinsurance percentage, whether the deductible applies, and how much of the deductible you have met this year.
• The phone. Call the number on the back of the card, or the behavioral health number if there is one, and ask: Is outpatient mental health covered? What is my copay or coinsurance for a licensed therapist, and for a psychiatric nurse practitioner? Does my deductible apply first, and how much is left? Are video visits covered the same as office visits? Do I need prior authorization? Note the date and the answers.

What PATH does with that

You do not have to finish the homework before you call us. Every patient starts with a free 15-minute video consultation with our front desk. Bring the card. We ask which plan you have, we check your coverage, and you hear the dollar amount for your situation before anything is final. The consultation is about cost and next steps; it is not the evaluation or the first session, and it commits you to nothing.

Where the bill comes from

Billing for Cigna, along with Aetna, Carelon Behavioral Health and Curative, is handled by our billing partner, Headway. After you book with one of those plans you get an email from Headway to confirm your coverage and add a card for your copay or coinsurance, and you see your estimated cost there before your first session. The claim goes to Cigna from Headway. If the estimate does not match what your plan told you, call us before the first visit and we sort it out.

If Cigna turns out not to be your plan, or not to pay

• A plan we do not accept. If it turns out your plan is not one of the four we accept, you can still see us: you pay our self-pay rate, we give you a superbill after each session, and your plan may pay you back for part of it. How out-of-network benefits work, in four steps.
• A high deductible. The visit is covered, but until the deductible is met you pay the agreed price per session, and every dollar counts toward it. We tell you the number on the consultation, so there is no surprise at the first visit.
• Paying yourself. Therapy is $75 to $150 a session, a psychiatric evaluation is $300 and a medication management follow-up is $150, the same by video as in person, with a sliding scale for financial hardship. Every price is on the insurance and pricing page, and you get a written Good Faith Estimate before your first appointment.