Psychotherapy and health insurance: an overview
A person’s soul can hurt just as much as their body. When this happens, it’s vital that they get psychological counselling quickly. And they need to take the right steps to ensure that their health insurance pays for the psychotherapy.
Psychotherapy: when the soul is hurting
Whether it’s depression following the loss of someone close to us, burnout as the result of too much stress or sudden feelings of anxiety: there are many ways in which our mental health can be thrown off balance. Sometimes our inner balance is so upset that our usual coping mechanisms no longer work. We're left feeling overwhelmed, insecure, maybe even hopeless.
Children are affected too
Parents and paediatricians are increasingly seeking professional support and assistance for children and young people experiencing psychological distress.
It’s important to get help: health insurance pays a share of the costs
No matter whether a mental health crisis is caused by stress, life changes, painful events or some other form of trigger, it is vital that the patient gets help quickly and finds the right treatment.
Psychological counselling and psychotherapy are two of the most commonly used services.
Psychological counselling consists of a number of sessions with a qualified professional that focus on a specific issue such as conflict at work or learning difficulties. General health insurance doesn't pay a share of the cost of psychological counselling.
Psychotherapy treats more complex topics and medical conditions over a longer period of time. Psychotherapy is helpful when a person’s thoughts and feelings are having major adverse effects on their behaviour and quality of life.
Good to know
Psychotherapy is often a long-term form of treatment that can put a significant strain on the patient’s budget. That’s why it’s important to take the right steps from the very start.
- See your family doctor: consult your family doctor first and discuss what should happen next with them. Your family doctor will help you find a recognised specialist.
- Sort out the financing: ask your chosen specialist whether they charge for their services via basic or supplementary insurance.
- Notify your health insurer: ask your health insurance company what share of the costs it will pay for the planned therapy or counselling.
- This is what CSS pays: our Benefits Check in myCSS shows you right away what costs CSS will assume in your case.
Differences between basic and supplementary insurance
New rules governing the billing of psychotherapy services entered into force in July 2022:
- Basic insurance pays if psychotherapy has been medically prescribed by a doctor with suitable specialist qualifications.
- The chosen psychotherapist must be recognised under basic insurance.
- Supplementary insurance from CSS pays part of the cost of the therapy if the psychotherapist is recognised by CSS but not under basic insurance.
What does health insurance pay?
With accreditation & doctor’s orders
Referral by authorised doctor
Therapist recognised under basic insurance
30 sessions provided the legal requirements are met, minus deductible and retention fee
- Further sessions only with commitment to provide cover
Therapist recognised by CSS
Therapist recognised by CSS (but not accredited under basic insurance)
myFlex Outpatient Insurance covers part of the cost
75% from Balance level, capped at CHF 3,000 per calendar year
Professional treatment is vital
More and more people with mental health problems are currently on a waiting list for suitable treatment at a practice. These increasingly also include children and young adults – who shouldn't have to wait long to get the support they need, otherwise the problems they're experiencing could have a longer-term impact on their lives. If you wish to take action in the meantime, we recommend the CSS Health Coaches and Pro Juventute’s 24/7 parental advice service.
The CSS Health Coach is here to help
With the help of their very own Health Coach, persons insured with CSS can learn to cope better with physical or mental stress.