PacificSource Commercial Therapy Coverage

PacificSource provides commercial health insurance for large and small groups as well as individuals throughout the Pacific Northwest. They offer a range of insurance benefits for commercial policyholders that include help for mental health treatment and substance abuse treatment. 

PacificSource Commercial Addiction Treatment Coverage

Anyone with a commercial health insurance plan offered through PacificSource can apply their benefits to all mental health treatment, including addiction. You can apply benefits to some of the costs for things like:

• Medically supervised detox, including MAT programs
• Outpatient therapy, including individual, group, and family therapy
• Cognitive behavioral therapy
• Aftercare planning
• Medications 

Some of your treatment options for addiction might require pre-authorization from your primary care physician. When you reach out to Skycloud, our team can help you navigate this process, including the necessary paperwork your insurance provider requires before getting started.

PacificSource Commercial Therapy Coverage

PacificSource covers many different therapies, all of them evidence-based. Many of the covered therapies are those offered by Skycloud. 

Cognitive Behavioral Therapy

Cognitive behavioral therapy is a common form of treatment for things like depression or anxiety, one that we utilize with many of our clients. As a highly effective form of therapy, clients can use their PacificSource commercial therapy coverage benefits for this or corresponding DBT sessions. 

PacificSource also covers evidence-based therapies like EMDR. 

Eye Movement Desensitization and Reprocessing 

With Skycloud, we offer in-person and virtual EMDR therapy. This type of therapy is designed to help people process traumatic memories. Unlike traditional talk therapy, it actually focuses more on changing the way traumatic memories are stored in the brain through an eight-phase process with a licensed therapist. 

This means individuals don’t have to sit and talk about their trauma, but instead work to reprocess that event, reduce the emotional distress it has, and reduce the triggers associated with it.

It is not uncommon to use more than one type of therapy during your treatment plan, and with PacificSource, you can still apply your benefits as long as the therapist with whom you work meets your insurance requirements. 

PacificSource Commercial Therapy Coverage

With PacificSource, commercial therapy coverage is included for in-network and out-of-network providers. The costs that you pay out of pocket versus what the insurance company pays are based on the specific plan you have. 

Most plans will cover part of a therapy session, but not all of it, and you generally have to pay a coinsurance or copay for each session. 

In-Network versus Out-of-Network

Unlike many insurance providers, PacificSource lets you find a therapist with whom you are comfortable, who works well for your condition, regardless of whether they are considered in-network. 

Someone who is “in-network” already has approval with your insurance company, including things like set fees for their services so they are very likely easier to get a referral with, and may cost less out of pocket but someone who is “out-of-network” can still provide you therapy while using some of your benefits and might have more privacy. 

The Average Cost of PacificSource Commercial Therapy Coverage

If you are struggling with a mental health disorder or addiction, you can apply some of your insurance benefits to the cost of therapy. 

In general, the cost differs for an in-network versus an out-of-network therapist. 

• An in-network therapist will typically require a copay between $40 and $100 per visit
• An out-of-network therapist will typically cost 50% of the session fee after you have paid your deductible

Each plan with PacificSource comes with a deductible. This refers to the amount of money you have to pay out of pocket for any and all health-related services before your insurance will kick in to cover some or all of the balance for any treatment you receive for the rest of the year.

For PacificSource commercial therapy coverage, once you meet your deductible, which includes costs for any other health care services you receive throughout the year, you’ll typically be responsible for half of your out-of-network therapy sessions.

So, if you have an in-network therapist like Skycloud, you might only pay an average of $50 per visit, depending on your plan, versus working with someone outside of your insurance network, where you might have to pay $125 out of pocket if the session is $250.

The exact pricing is based on the commercial plan that you have, and you can check with your summary of benefits, you can call the customer helpline listed on the back of your insurance card, or speak to your HR representative to figure out what your coverage is. 

Online Versus In-person Therapy Costs

With PacificSource, commercial therapy coverage applies to in-person or online therapy so long as it meets the other conditions, like an evidence-based modality. If you start online therapy with an in-network provider, PacificSource will cover 100% of your costs. 

This benefit is only available through the members-only online platform, Teladoc, where you can connect with in-network therapists. 

If you want to go outside of that platform, you are more than welcome to, but the costs then revert to the same in-person costs. 

Referrals with PacificSource

Depending on the plan you have, you might need a referral from your primary care physician before you can start any type of therapy. All HMO plans require a referral from your primary care physician, which can be done through the online Teladoc platform. PPO plans don’t need a referral to start therapy, however.

Find The Help You Need

If you have PacificSource commercial health insurance, you can apply your benefits to therapy for mental health and addiction treatment. The percentage you have to pay out of pocket for services like online versus in-person therapy sessions is based heavily on the plan type you have and whether you are choosing to work with a therapist who is in-network or not. 

When you reach out to our team at Skycloud, we can help you check the type of plan you have and review your benefits so that you have a more thorough understanding of what costs might be expected out of pocket versus what is covered by your insurance provider. Given that many services require a pre-existing diagnosis or referral from your primary care physician, our team can also help you determine what paperwork needs to be submitted, when. 

Contact our team today to get started. 

FAQ

What Mental Health Conditions Can I Treat with PacificSource?

If you have PacificSource as your commercial health insurance, you can get treatment for many conditions, including:

• Depression
• Anxiety
• Eating Disorders
• OCD
• Substance Abuse

Is There Any Therapy PacificSource Won’t Cover?

PacificSource commercial therapy coverage is limited to evidence-based treatment. This means your benefits cannot be applied to things like life coaching or career coaching. Other holistic care, though evidence-based, is not included in commercial insurance benefits, including massage therapy, nutrition therapy, aromatherapy, or ketamine treatment. 

How Can I Check My PacificSource Commercial Addiction Treatment Coverage?

The easiest way to review your benefits and figure out what is covered for therapy or addiction treatment is to look at your summary of benefits. This is something you can typically find in an online portal, as it is sent once a year, but you can also contact your HR team if you have a commercial plan provided by your employer to further discuss what is available.

Our team can also help you review your benefits and find out what aspects of treatment might be covered for you. 

Does PacificSource Have to Know What My Therapy is For?

Technically, this comes down to whether you are working with a therapist who is in-network or not. If you are, you will be diagnosed during your initial assessment, and that diagnosis will be conveyed to your insurance company. Thereafter, your therapist will provide your insurance company with updates on your prognosis as they continue to monitor the efficacy of the treatment you receive.

If you do not want your insurance company to know what you are receiving treatment for, you can opt for private therapy through an out-of-network option, knowing that it will cost slightly more.