Insurance routes · 72 pages

Insurance routes

Plan-by-plan walkthroughs with the exact scripts — Kaiser, Medi-Cal, Anthem, Blue Shield and more. The 10-business-day law applies to nearly all of them.

Start with what you have

The four routes almost everyone in California is on. Each one is a walkthrough, not an overview.

MEDI-CAL

Medi-Cal therapy: start here

Find Medi-Cal therapy through your health plan or county. Check covered costs, Share of Cost, and what to say when asking for care.

MEDICARE

Medicare and therapy: the route that opened up

Medicare now covers LMFTs and counselors — the 2024 change that widened the bench. Part B math, Advantage plan traps, in-home telehealth, and the exact steps.

COVERED CALIFORNIA

Buying a Covered California plan? Here's how to pick one that's good for therapy.

Every Covered California plan carries the 10-day right and full parity. The real differences: metal tiers, copay structures, and networks. The math.

EAP

Your job probably already pays for therapy. Here's the EAP decoder.

Most California employers offer an EAP: free therapy sessions, no insurance, no diagnosis on file. How to find yours, what to say, and the catches.

Your carrier, by name

What each plan actually does with a therapy claim, and the words that move it.

KAISER

Kaiser owes you a therapy appointment within 10 business days. Here's how to get it.

Kaiser must offer you a mental health appointment within 10 business days — including follow-ups. The exact scripts to use, and what to do when they miss.

ANTHEM

Anthem covers therapy. Here's the route through California's biggest network.

Anthem members have the 10-day right, a huge PPO network, and superbill leverage. The scripts, the phone numbers, and the self-funded catch.

BLUE SHIELD

Blue Shield of California covers therapy. Here's the route.

Blue Shield members hold the 10-day right. How to get names that answer, force out-of-network coverage when they don't, and escalate free.

HEALTH NET

Health Net covers therapy. Which door depends on which Health Net you have.

Commercial, Covered California, or Medi-Cal — Health Net runs all three, and the therapy route differs. Sort your card, then use the scripts.

BAY AREA

UC Law SF staff: Health Net therapy and a searchable therapist directory

Search 944 San Francisco Health Net therapist records, call offices directly, compare 2026 UC employee mental health benefits, and follow the exact booking route.

AETNA

Aetna covers therapy. The route — and the self-funded catch most members hit.

Many California Aetna members are on self-funded employer plans where state deadlines don't bind. What still protects you, and the scripts.

CIGNA

Cigna covers therapy. Here's the route through Evernorth.

Cigna behavioral health runs through Evernorth. The scripts for names that answer, the self-funded check, and the free-session benefit inside.

UNITEDHEALTHCARE

UnitedHealthcare covers therapy — through Optum. Here's the route.

UHC members reach therapy through Optum Behavioral Health and the Live and Work Well portal. The scripts, the clock, and the escalations.

When nobody is in network

The routes that work when the plan has no one, or no one you want.

OUT-OF-NETWORK

"I don't take insurance" doesn't mean you can't use yours. The superbill route.

A superbill turns a cash-pay therapist into a partly-reimbursed one — often 50–80% back after deductible on PPO plans. The 4-step route with real math.

Medi-Cal, county by county

Every county runs its own specialty door and its own set of managed care plans. There is a page for each — with that county's own line, the date we read it, and the script for both doors.

Everything else

ACCESS FAILURE

Kaiser says nobody is available: make the plan own the search

A California call script and evidence log for Kaiser members offered no therapist—or one too late. Learn when to request arranged care and escalate.