The Hidden Language of Insurance: What Your Policy Isn’t Telling You
When you walk into therapy, the last thing you want to think about is insurance jargon. If you’re using insurance to pay for sessions though, it matters. Insurance has its own language and if you don’t know it, you can end up with surprise bills or limited care.
At The Existence Collective, I believe in pulling the curtain back. Here’s what insurance doesn’t spell out for you, why medical necessity is so important, and why your therapist’s notes sometimes sound like a robot wrote them.
1. Medical Necessity Is the Gatekeeper
Insurance does not cover therapy just because it’s supportive or helpful. To approve payment, they require proof that treatment is medically necessary. That means:
You meet criteria for a diagnosable mental health condition like Generalized Anxiety Disorder, Major Depression, or OCD.
The symptoms are clearly interfering with daily life, work, relationships, or functioning.
There is a treatment plan in place to address those symptoms.
This does not mean your therapist thinks you are broken. It means they have to translate your struggles into the kind of language an insurance reviewer will sign off on.
2. Session Length Codes Are Not Just Numbers
On claims you’ll see terms like 90834 or 90837. These are CPT codes, billing shorthand that tells insurance what happened.
90834 = 45 minute therapy session
90837 = 60 minute therapy session
Insurance often wants to limit 60 minute sessions. If you have them, your therapist is probably writing extra justification so you actually get the time you need.
3. Why Therapy Notes Sound Clinical
If you ever request your notes, you might notice they read more like a checklist than a conversation. Notes are written to show:
Diagnosis and symptoms observed
Interventions used such as CBT, EMDR, mindfulness
Progress toward goals
Risk assessment around safety and harm
They are less about your story and more about proving to an auditor that care was necessary. Your therapist is trying to protect your privacy while also documenting enough to keep sessions covered.
4. Common Terms That Confuse Everyone
Deductible – what you pay out of pocket before insurance starts covering.
Copay – a fixed fee per session, no matter the cost.
Coinsurance – your percentage of the bill after the deductible is met.
Out-of-Network (OON) – providers not contracted with your plan. Coverage here is often partial or nonexistent.
Tip: even if you ask insurance “Do you cover therapy?” the real answer depends on these variables. Always check your exact plan.
5. How This Protects You
Accurate notes and diagnoses may feel like red tape but they protect you. They make sessions more likely to be covered, reduce your risk of surprise bills, and keep your therapist compliant so your care is stable.
The Bottom Line
Insurance does not make therapy simple. But knowing how the language works puts you in a stronger position. At The Existence Collective, I see education as part of the care process. When you understand what “medical necessity” or “90837” really means, you are no longer a passive patient. You become an informed participant in your own treatment.
