Therapy costs nearly Rs 2,000 a session. Can your health insurance help?

A therapy session can cost Rs 2,000 or more. For someone seeing a therapist every week, that means spending at least Rs 8,000 a month and over Rs 1 lakh a year. It is a significant recurring expense, especially when the person is already paying an annual premium for health insurance.So, it is reasonable to expect the policy to help with these expenses. After all, under Section 21(4) of the Mental Healthcare Act, 2017, insurers are required to provide medical insurance for the treatment of mental illness on the same basis as physical illness. IRDAI has also directed insurers to comply with this requirement.But there is an important distinction between mental illness being covered under the rules and your insurer actually paying for your therapy sessions.A policy may cover hospitalisation for mental illness without reimbursing regular outpatient therapy. Another may offer a limited number of counselling sessions through an app but not pay for appointments with a therapist of your choice. In other words, having mental health coverage does not necessarily mean every therapy session, psychiatric consultation or counselling appointment will be covered. “Parity in coverage, not an unlimited promise to pay for every form of care,” says Saurabh Vijayvergia, Founder and CEO of CoverSure.The question, then, is not simply whether mental health is covered by health insurance. It is whether the policy you are paying for will help with the treatment you actually need.MENTAL HEALTH COVERAGE IS MANDATORY. BUT WHAT DOES THAT MEAN? The starting point is the Mental Healthcare Act, 2017. Section 21(4) requires insurers to provide medical insurance for the treatment of mental illness on the same basis as the treatment of physical illness.IRDAI directed insurers to comply in August 2018 and reiterated in October 2022 that insurance products must cover mental illness and comply with the Act. According to Vijayvergia, the regulator has also asked insurers to offer products for persons with mental illness, backed by underwriting policies that do not reject an application solely on that ground.“Mental illness cannot simply be excluded as a category from medical-expense cover,” he says.That is an important protection for policyholders. Mental illness cannot simply be treated as a category that health insurance does not cover.However, the mandate should not be interpreted as a promise that every mental health expense will automatically be reimbursed. The type of policy, the treatment sought and the benefits purchased still matter.As Vijayvergia explains, “A hospitalisation policy does not automatically become an outpatient policy, and a fixed-benefit policy pays according to its specified benefit triggers rather than reimbursing every treatment bill.”In other words, the requirement to cover mental illness does not automatically mean that a policyholder can submit bills for every therapy session and expect payment.The real question is what kind of mental healthcare the policy covers, under which benefit and subject to what conditions.YOU NEED THERAPY. WILL YOUR INSURER PAY FOR IT?Consider someone who has been attending therapy every week. The sessions cost Rs 1,500 each, and the expense is becoming difficult to manage. The person has health insurance and knows that mental illness is covered under the rules. Naturally, they want to know whether they can submit the bills to their insurer.The answer depends on the policy.“For many people, regular therapy is where recovery actually happens, so it helps to know exactly how a policy treats it,” says Vijayvergia.He points out that for therapy outside a hospital, the policy needs an applicable outpatient benefit, a psychotherapy or counselling benefit, or a service benefit that provides eligible sessions. This could be included in the base policy, offered as an optional cover or provided through an employer's benefits package.There is another distinction that policyholders should not overlook: whether the insurer reimburses the cost of treatment or simply gives access to a limited service.“Check whether the benefit pays your chosen therapist's bills or only provides sessions through the insurer's own network or app,” Vijayvergia says. “Those are materially different benefits.”For example, a policy may provide a fixed number of virtual counselling sessions through an app. That can be useful, but it is not the same as reimbursing regular appointments with an independently chosen therapist.Similarly, treatment connected to an admissible hospitalisation may qualify under pre- or post-hospitalisation cover, subject to the treatment link, eligible expenses and the specified time window. That does not automatically provide continuing cover for unrelated outpatient therapy.This is why checking whether a policy covers mental illness is only the first step. Policyholders also need to establish whether the specific treatment they need is covered.THERAPY, COUNSELLING AND PSYCHIATRIC TREATMENT ARE NOT THE SAME BENEFITAnother source of confusion is the assumption that all forms of mental healthcare fall under one insurance benefit.Mental healthcare can include assessment, diagnosis, treatment, care and rehabilitation for mental illness or suspected mental illness. Psychotherapy and clinical counselling are part of that care.Vijayvergia says therapy should not be dismissed as a wellness extra simply because it involves conversation rather than a prescription.However, whether an insurer pays for a particular service is a separate question.A hospitalisation policy may cover eligible inpatient treatment, while outpatient psychiatric consultations, medicines and psychotherapy depend on the relevant outpatient benefits.It is also important to distinguish clinical treatment from general wellbeing support. Some policies offer counselling for stress, parenting or relationship concerns as a separate service benefit, with eligibility conditions that differ from those for a medical-expense claim.“Neither a formal diagnosis nor a psychiatrist's referral should be described as a universal requirement for every counselling benefit,” Vijayvergia says.For consumers, the takeaway is straightforward: do not assume that a policy offering counselling automatically covers clinical therapy, or that psychiatric consultations, prescribed medicines and psychotherapy all fall under the same limit.Check each benefit separately and understand what the insurer will pay for.THE FINE PRINT THAT CAN LEAVE YOU PAYING THE BILLEven when a policy includes mental health coverage, several conditions can affect how much a consumer can actually claim.The first is the setting in which treatment is provided. Does the policy cover hospital treatment, outpatient treatment or only a specified number of virtual counselling sessions?Next, look at the financial limits. These can include an annual allowance, a cap on the amount payable per session, a maximum number of sessions, co-payment requirements or a shared limit that also applies to other outpatient expenses.“A large hospitalisation sum insured tells you very little about what is available for regular therapy,” Vijayvergia says.For instance, a policy may advertise a large overall sum insured but provide only a small outpatient allowance. Even if therapy is eligible, that allowance may be exhausted after a few sessions.The provider conditions matter just as much. A benefit may require treatment by an eligible professional, restrict access to approved providers, require bookings through an app or ask for supporting clinical records.Policyholders should also check waiting periods, including those applicable to disclosed pre-existing conditions. Vijayvergia notes that under IRDAI's framework, the waiting period for disclosed pre-existing conditions is capped at 36 months of continuous cover, although a policy may offer a shorter period.Any restriction that specifically applies to mental illness deserves careful scrutiny against the statutory requirement of parity, he says. Not every restriction printed in a policy is necessarily compliant.The practical point is that a policyholder should not stop reading after finding the words “mental health covered”. The conditions attached to the benefit can determine whether the policy helps with the treatment they actually need.HOW TO CHECK YOUR POLICY IN FIVE MINUTESYou do not necessarily need to read every page of your policy document to begin understanding your coverage. But you do need to check the right sections.Vijayvergia suggests starting with the policy schedule to confirm the exact plan, variant and optional benefits purchased. Then look at the Customer Information Sheet, or CIS, which provides a summary of the policy's coverage, exclusions and financial limits.Next, search the detailed policy wording for terms such as “OPD”, “outpatient”, “psychotherapy”, “psychologist”, “counselling”, “psychiatric”, “mental illness” and “e-counselling”.But finding one of these terms is not enough. Read the complete clause and its conditions.“You are looking for three answers: which service is covered, who can provide it, and how much the policy pays,” he says.There is one more question to ask: does the policy reimburse the bills you submit, or does it only give you access to a specified number of sessions through its own platform or network?If the wording is unclear, ask the insurer for a written explanation. Vijayvergia suggests asking:“Will this policy pay for recurring outpatient psychotherapy with my chosen provider? Please identify the clause, limits, waiting period and documents required.”That is more useful than simply asking customer service whether mental health is covered. A broad yes may not tell you whether your particular therapy sessions qualify.CAN YOUR CLAIM STILL BE REJECTED?Yes. The fact that a policy covers mental illness does not automatically make every expense admissible.Vijayvergia identifies several situations in which a claim may be rejected or restricted: outpatient bills submitted under hospitalisation-only cover, an incomplete waiting period, an exhausted allowance, treatment outside the eligible provider or service conditions, or missing supporting records.Sometimes the claim may not be rejected entirely but may be restricted because an expense exceeds the applicable benefit limit or attracts a co-payment.If a claim is refused, ask the insurer to provide the precise contractual reason in writing.“A denial simply because the treatment is for mental illness is very different from a denial because a particular outpatient expense falls outside the benefit purchased,” he says.If the explanation does not appear justified, policyholders can use the insurer's grievance process and, subsequently, approach the Insurance Ombudsman where appropriate.There is also an important limitation in the available data. Vijayvergia notes that, in July 2026, the government told Parliament that IRDAI collects data on overall claim repudiations but not on the reasons behind individual denials. That means there is no reliable official ranking of the reasons mental health claims are refused.Possible grounds for rejection can be explained, but they should not be presented as the most common reasons across the industry without supporting data.WHAT IF YOUR POLICY DOES NOT COVER REGULAR THERAPY?Discovering that your policy will not reimburse regular therapy can be frustrating, particularly when you are already paying an annual premium. But there are other avenues worth checking.Start with your employer's benefits. Some companies provide counselling through an employee assistance programme or a separate mental health service, even when their group health insurance does not reimburse therapy bills.You can also ask your insurer whether an outpatient or counselling benefit can be added, or whether another plan would better meet your needs. However, the availability of such benefits and when they can be added depend on the specific product. Do not assume that an additional benefit can be activated immediately or that it will cover treatment already received.Before buying a new policy or changing your cover, check the acceptance terms, waiting periods and eligibility of ongoing treatment. Disclose the treatment history requested in the proposal form, and if you are switching policies, confirm how continuity credits apply.Years of hospitalisation cover do not automatically eliminate waiting periods on a newly added outpatient benefit, Vijayvergia cautions.He also stresses that people should not postpone seeking help simply because they are trying to resolve an insurance question.“Your wellbeing comes first; the financing can follow,” he says.For those who need immediate support, the Government of India's Tele-MANAS service offers free, round-the-clock tele-mental health support at 14416 or 1-800-891-4416.WHAT SHOULD YOU LOOK FOR WHEN BUYING HEALTH INSURANCE?If mental healthcare is important to you, the time to check the coverage is before buying or renewing a policy, rather than after the first therapy bill arrives.“‘Mental health covered’ is a starting point, not the finish line,” Vijayvergia says.Someone expecting to attend therapy regularly should look for clear coverage of outpatient psychotherapy or clinical counselling. They should also check the qualifications required of the provider and whether they can use their preferred therapist.Compare the annual allowance, payment limit per session, number of sessions, co-payment, waiting periods and access process. Check psychiatric consultations and prescribed medicines separately from therapy.Most importantly, compare the available benefit with the actual cost of care.At Rs 2,00 a session, four sessions a month add up to Rs 80,000 a year. A policy that provides a few complimentary consultations may be useful, but it offers a different level of financial support from one that helps pay for sustained therapy.“The practical test is simple: can this policy support the care you expect to need, through a payment and access process you understand before treatment begins?” Vijayvergia says.The question is no longer just whether your health insurance covers mental illness. It is whether the cover is useful for the treatment you are likely to seek.That distinction can make a substantial difference to someone managing recurring healthcare expenses. A policy may meet the broad requirement of covering mental illness, but a consumer still needs to understand its limits, exclusions and payment process to know what protection they actually have.As Vijayvergia puts it, “Insurance should make that first step lighter, not add another layer of doubt.”For anyone paying nearly Rs 2,000 a session, five minutes spent checking the policy could help establish whether the insurer will share the bill — or whether the expense will have to come out of their own pocket.- Ends