Why the answer is "it depends"
There is no single rule for whether therapy for a sexual or intimacy concern is covered. The American Psychological Association (APA) notes that private health insurance and managed care plans may cover mental health services such as psychotherapy, and that you should check with your plan before you start. It also notes that insurance companies vary in which mental health conditions they cover, so some policies may not cover certain conditions.
For sexual concerns, that leaves real room for variation. A problem with desire, anxiety or closeness can sit alongside depression, anxiety, trauma or relationship strain, and how a plan treats each of those can differ. Plans can also differ on couples sessions. The only reliable answer comes from your own plan, which is why a short phone call before your first appointment is worth the time.
Questions to ask your insurer
Call the member services or behavioral health number on your insurance card. The APA suggests asking whether your plan covers mental health services, whether it covers psychologists, and which kinds of treatment are covered or excluded. For a sexual or intimacy concern, these questions are worth adding:
- Do I have outpatient mental health benefits, and is the psychologist I am considering in network?
- Does my plan cover individual psychotherapy, couples or family psychotherapy, or both?
- Are any kinds of concerns or treatments excluded from coverage?
- What is my deductible, how much of it have I met, and what is my copay or coinsurance per session?
- Is there a limit on the number of sessions per year?
- Do I need approval from my primary care physician first?
- Are telehealth sessions covered the same way as in-person sessions?
- If the provider is out of network, how much will my plan reimburse, and what paperwork does it need?
There are questions for the practice, too. The APA suggests asking a psychologist which insurance they accept, whether they will bill your insurer directly, and what their policies are on missed appointments. Asking these before the first session means the first bill holds no surprises.
Write down the date, the name of the person you spoke with and what they told you. If an answer is vague, it is fine to ask the representative to check, or to call back and ask again. Dr. Lehmann's practice is in network with Blue Cross Blue Shield PPO, but individual plans differ, so it is still worth confirming your own benefits.
Paying privately and the Good Faith Estimate
Some people pay privately because they have no insurance, their plan does not cover what they need, or they would rather keep their insurer out of a sensitive matter. How Private Is Therapy for Sexual Concerns? looks at privacy and insurance in more detail.
If you pay privately, the federal No Surprises Act, which took effect on January 1, 2022, gives you a specific protection. According to the Centers for Medicare & Medicaid Services (CMS):
- If you are not using health insurance, your provider usually must give you a Good Faith Estimate of expected charges if you ask for one or schedule at least 3 business days in advance.
- You can ask for an estimate before you schedule, and the provider must give it to you within 3 business days.
- You may be able to dispute a bill that is at least $400 more than the estimate. You cannot dispute a bill without an estimate, so keep your copy.
- If you think you should have received an estimate and did not, you can submit a complaint.
CMS also runs a No Surprises Help Desk at 1-800-985-3059 for questions about these rights.
Dr. Lehmann's fees, as currently listed
The practice currently lists the following. Fees and policies can change, so confirm the details when you call:
- Private pay: $220 per clinical hour.
- Insurance: in network with Blue Cross Blue Shield PPO.
- Reduced fee: reduced-fee services are available on a limited basis. Ask whether a spot is open.
- Late cancellation: please give 24 hours' notice. Missed sessions or late cancellations are billed $90 unless due to illness or an emergency.
If you are thinking about couples sessions, ask Dr. Lehmann about fees and session length for couples work when you call. The Fees & Insurance page and the cancellation policy have the full details.
If cost is a barrier
Cost does not have to rule out support. The APA and the National Institute of Mental Health (NIMH) both suggest asking any therapist you are considering whether they have a sliding-scale fee based on income. The APA notes that employers may offer an employee assistance program, which typically provides a small number of sessions free or at very low cost. Community mental health centers and university training clinics are other possible options the APA and NIMH mention.
Some people also plan around a set number of sessions, focusing first on the most pressing part of the concern, and review after several weeks whether the work is helping enough to continue at the same pace. Being open about what you can afford is a normal part of planning care, not an awkward request.
The medical side is a separate bill
Many sexual concerns have a physical part that belongs with your physician, gynecologist or urologist: pain, changes in erection or ejaculation, hormonal changes, or side effects of a medication. Those visits are separate from therapy, your plan's medical benefits are the place to ask about their cost, and it often makes sense to have them first. Therapy with a psychologist focuses on the emotional and relationship side and works alongside medical care. Learn more about therapy for intimacy and sexual concerns with Dr. Lehmann.