If you have Green Shield benefits, one of your first questions is probably "does Green Shield cover a psychologist, or therapy at all?" It's a fair thing to ask before you book. The honest answer is that it depends on your plan, the type of professional and the service. Green Shield (also written GreenShield) plans differ from one employer to the next. This guide shows where to look, what to ask and how claiming works, without guessing about your plan.
This article is general information, not a promise of coverage. Only your own plan and Green Shield can tell you what is covered.
The short answer, and why it depends on your plan
No one outside your plan can tell you exactly what you're covered for, and that includes us. Green Shield plans are set up by employers, unions or individuals, and each one chooses its own list of benefits. Two people with Green Shield cards can get two different answers.
Most people start by asking about three things: the type of professional, the type of service and what's left of their yearly benefit. CAMH notes that psychologists' fees are not covered by most provincial health plans. That is why so many people turn to private benefits like Green Shield for this kind of care.
Where to look in your plan
Green Shield publishes the steps itself, so you can find out without calling anyone. Here is how it describes them.
Your benefit booklet. Green Shield says that if your booklet is available through your online account, you can reach it by signing in, opening "Your Account" and then "Coverage." Look for the link under "Benefit Booklet."
Check your coverage. Green Shield's Check Your Coverage page explains how to choose a service, pick who it is for, enter a date and an estimated amount, and see your coverage results.
Your claims history. If you have used your benefits before, your online account is a good place to see what has been paid so far this year.
If you can't find your booklet, your employer's benefits contact or the number on your Green Shield card can point you to it. Your plan documents always win over anything you read online, including this article.
You don't have to read every page. Look for the words mental health, psychology, psychotherapy, social work and assessment. Those few lines usually hold the answer.
Psychologists, psychotherapists and social workers, how plans usually list them
Plans often list mental health care by the type of professional. Green Shield's own help article on counselling and mental health services says many types of professionals can provide counselling, including psychologists, Masters of Social Work and psychotherapists. It then points you to the Check Your Coverage tool to see if you're eligible.
That is a useful clue. When you check, look for lines such as psychology, psychotherapy or social work, and see whether they are separate or share one amount. Some plans group them together. Others don't.
At our clinic, Registered Psychotherapists (RPs) and Registered Social Workers (RSWs) provide therapy, and our psychologists assess and diagnose. For how Green Shield treats social workers, see our page on Green Shield and social workers.
Psychological assessments, and what to ask about them
Assessments are a different kind of service from weekly therapy. Some plans treat them under the psychology benefit, and others treat them differently or not at all. We can't say which applies to you.
When you check, name the service exactly, such as "psychological assessment" or "ADHD assessment." Ask Green Shield whether it counts toward your psychology benefit and whether any paperwork is needed. Our psychologists can assess and diagnose. Assessment fees depend on the service, and we go over them with you in your free consultation.
Couples and family sessions
Some plans cover couples or family sessions, and some only cover individual sessions. The answer can also depend on who is named on the claim. Before you book, ask whether couples therapy is covered and how a session for two people is processed.
Our couples and family sessions are $170 to $200. Individual sessions are $130 to $200, and student therapists offer sessions for $0 to $80. Depending on your plan, your insurance may cover the full session fee.
Why the answer can change
Your answer today may not be your answer next year. Plans can change when your employer renews them, when you change jobs or when a new benefit year starts. If you checked a year ago, check again before you book.
It also helps to know what kind of "no" you got. A service may not be covered at all. It may be covered, but only for certain professionals. Or it may be covered, and you've simply used up this year's amount. Each of these points to a different next step.
Claiming and direct billing
There are two common ways to use your benefits.
Pay and claim. You pay at your session, then submit the receipt to Green Shield. Green Shield has a help article on how to submit a claim in the app or on the website. It says that, depending on your plan and claim type, you may need to upload receipts or other supporting documents.
Direct billing. The clinic sends your claim to your insurer, and you pay only what your plan doesn't cover. We can direct bill many plans, and you can read more on our direct billing page. Ask us whether we can direct bill your plan.
Whichever way you go, keep your receipts. A good receipt shows the date, the amount paid, the type of professional and the provider's details.
Questions to ask before you book
You don't need to be an insurance expert. A short list of questions gets you most of the way.
Which professionals are covered, such as psychologists, psychotherapists or social workers?
Is there a yearly maximum, and is it shared between types of professionals?
How much of this year's benefit is still available?
Is there a limit per session, or a percentage that is paid back?
Do I need any paperwork, report or note before I claim?
Is the exact service I want covered, whether therapy, couples therapy or an assessment?
Write down the date and the name of the person you spoke with, so you can refer back to it later.
If your plan covers less than you hoped
A smaller benefit doesn't mean therapy is out of reach. You can use what your plan gives you and cover the rest another way. Many people spread their sessions across the year, or choose a lower-cost option for some of them.
Tell us your budget in your free consultation. We'd rather you start with a plan you can keep up than stop halfway because the cost surprised you.
What our one-time fee covers
New clients pay a one-time $50 setup fee. Insurance doesn't usually cover it, and we don't charge it for the free 15-minute consultation. If you want help sorting out your plan before your first session, our team will talk it through with you during that call.
Other ways to pay
If your plan doesn't cover enough, or you have no plan, there are still choices. Student therapists offer sessions for $0 to $80. We also accept Health Spending Accounts. Our guide to insurance and therapy in Ontario lists more ways to cover the cost.
Frequently asked questions
Will my plan cover a psychologist?
Many plans list psychologists, but each plan sets its own rules and amounts. Use Green Shield's Check Your Coverage tool or your benefit booklet to see your own answer.
Can I find out before my first session?
Yes. The Check Your Coverage tool lets you enter an estimated amount and a service date before you book. Green Shield can also answer questions about your specific plan. Their frequently asked questions cover claims and online services.
Is couples therapy covered?
Some plans include couples sessions and some don't. Ask Green Shield before you book, and name the service as couples therapy so the answer fits what you're booking.
Do you promise my session will be covered?
No. Coverage is decided by your plan, not by us. We can tell you our session fees and talk through how billing works, but your insurer makes the final call.
Start with a free conversation
You don't have to figure this out alone. Book a free 15-minute consultation to ask about our team, our fees and how billing works. We see clients in person in Waterloo, Kitchener, Cambridge and Ottawa, and online across Ontario. No referral is needed. For general background on therapy itself, NIMH explains how talk therapy works.