Do I need a referral from my primary care provider to start therapy?

For most commercial insurance plans, no. You can contact Sprout directly to begin the screening process. Some HMO plans require referrals — we'll help you check during your screening.

Will my insurance cover couples or family therapy?

Possibly. Insurance only covers couples and family sessions when they are medically necessary to treat the diagnosis of one identified family member. Sessions cannot be solely focused on relationship growth or communication skills as a standalone goal.

Will my insurance cover telehealth therapy?

Most commercial plans currently cover telehealth at the same rate as in-person sessions, but rules can change. We verify telehealth coverage as part of your benefits check during the screening process.

How does insurance benefits verification work at Sprout?

During your screening call, our Intake Coordinator collects your insurance information. Our billing team then verifies your benefits before your first session. If there are surprises — preauthorization required, lower-than-expected coverage, or other issues — we let you know before care starts.

What if my insurance plan changes mid-treatment?

We'll work with you to transition. If your new plan is in-network with Sprout, we continue care without interruption. If it isn't, we'll discuss out-of-network reimbursement or self-pay options. We do not drop clients mid-treatment because of insurance changes.

Can I use my HSA or FSA for therapy at Sprout?

Yes. We accept HSA and FSA cards for copays, deductibles, and self-pay sessions.

What happens if my insurance denies a claim?

You would be responsible for the session cost. We try to flag potential issues during benefits verification, but insurance can deny claims after the fact. Reviewing your Summary Plan Description and contacting your insurance company directly before starting care reduces this risk.

Does Sprout handle secondary insurance?

Yes, in limited cases. Secondary insurance only pays if your clinician is in-network with both plans. Tell us during your screening if you have dual coverage so we can verify whether secondary coverage applies.

insurance basics

Sprout Therapy PDX is in-network with most major commercial insurance plans serving Oregon — Aetna, Kaiser, PacificSource, Providence, and Moda — plus most Oregon Health Plan (OHP/Medicaid) CCOs. We're a queer-founded, COA-licensed outpatient behavioral health practice offering therapy, medication management, and coordinated team-based care across our two Portland offices and via telehealth statewide.

If you have insurance and want to start therapy, book a free phone screening — we'll verify your benefits before your first session.

types of insurance coverage

Comparison chart of healthcare coverage options including Medicaid, Private Insurance, Medicare, and Secondary Insurance, with descriptions and important notes for clients.

How do I avoid unexpected balances?

The best way to prevent surprise balances is to fully understand your insurance benefits and keep us updated on any changes to your coverage.

You are responsible for:

Verifying your benefits before starting care.
Informing us promptly of any changes or lapses in private insurance or Medicaid.
Updating us if major life changes occur that may impact your coverage (e.g., marriage, pregnancy, changes in disability status, turning 65, moving, or changing jobs).

While we can usually estimate your copay, if your plan has a deductible or coinsurance, your final cost can vary. We bill for coinsurance or deductible amounts after your claim processes, since other medical visits you have may affect what you owe.

Claims can take 30–60+ days to process, so errors may not be discovered until you’ve already had multiple sessions.

insurance terms

A chart comparing different types of health insurance plans: Premium, Co-Pay, Deductible, Coinsurance, and Out-Of-Pocket Max, including definitions, payment due information, and examples for each plan type.

What mental health services does my insurance plan cover?

Coverage varies widely. Review your policy or contact your insurance provider directly to confirm:

Which services are covered.
Applicable copays, deductibles, or coinsurance.
Whether services are billed under an office visit or specialist rate.

Your Summary Plan Description will give more detail than your insurance card alone.

How do I verify my coverage?

Visit your insurance provider’s website.
Call the customer service number on your insurance card.
Review your policy documents.

Ask specifically about:

Copays, deductibles, and coinsurance for mental health.
Whether telehealth is covered.
Any preauthorization requirements.

We’re in network with:

Private Insurance
Aetna, Kaiser, PacificSource, Providence Health Plan, Moda.

Oregon Health Plan (OHP)
CareOregon, Columbia Pacific CCO, EOCCO, GOHBI, HealthShare, Intercommunity Health Network (IHN), Jackson Care Connect, Open Card, PacificSource Community Solutions, Trillium Community Health Plan, Umpqua Health Network CCO, Yamhill CCO
We cannot accept cash pay from OHP members.

Medicare
We are not currently in-network with Medicare and cannot accept cash pay from Medicare members.

What if my plan doesn’t cover mental health services?

Most private insurance plans offer some mental health coverage, but you may still owe part—or all—of the session fee through deductibles, coinsurance, or copays.
If your plan is employer-funded (your employer pays your health expenses directly), check carefully to confirm mental health coverage.

Do I need preauthorization for mental health services?

Some plans require preauthorization (prior approval) for mental health care. Call your insurance provider before starting sessions to confirm if this applies to you.

I still have insurance questions.

Contact our insurance and billing expert, Val!

Let’s get started.

book your screening call