How to pay for psychological help after a serious car crash

Insurance, work benefits, public programs and free help that can cover therapy

Safety Behind the Wheel Foundationdrivewithcare.org

Last reviewed:

For survivors and families50 min read

Emotional recoveryMental health supportHealth insuranceInsurance and claimsFinancial assistance

Paying the full price yourself is not the only option. Psychological care after a serious crash can be paid for from several places at once. No single source covers everyone. This guide walks through each route in the order most survivors need it. It starts with your own health insurance, then auto and injury claim coverage, workers’ compensation, public programs, workplace benefits, and free or low cost services.

These are U.S. rules. Which route applies depends on your state, your plan, your employer and who was at fault. Read each section as a list of things to ask about, not a promise of what you will receive. Don’t wait for a claim to be decided before you ask for help.

If you are in crisis right now, go to the box near the end of this guide, or call or text 988.

At a glance: where the money can come from

Use this table to see which routes might apply to you. Each row points to the section with the details and the limits. You may be able to use more than one route. Which one pays first depends on your state and your plan.

Comparison compiled by Safety Behind the Wheel Foundation

Where the money can come from

RouteWho it may helpA good first stepCommon catch
Your health insurancePeople with employer, Marketplace or other private coverageCall the member services number on your card and ask what therapy costsSelf funded employer plans follow federal rules, not state ones
Your auto insurance (PIP or MedPay)Policyholders and passengers, in states that offer itAsk your insurer in writing whether it pays for counselingShort notice deadlines in some states
The other driver’s insurance and injury claimsPeople hurt by another driverTalk with a licensed attorney in your state before you settleDeadlines and limits differ by state
Workers’ compensationPeople hurt while workingReport the crash to your employer and ask your state agency how to fileA regular commute is often not a work crash
Medicare, Medicaid, CHIP and VA carePeople who qualifyAsk the program what a therapy visit would costMedicaid rules change starting January 1, 2027
Help through workEmployees and often their familiesAsk HR about the Employee Assistance Program (EAP) and job leaveFree EAP sessions are limited
Free helpAnyoneCall or text 988 if you are in distressPeer support is not treatment
Low cost careAnyone with limited incomeAsk each clinic about a sliding fee scaleSliding fee does not mean free
Crime victim compensationPeople hurt in a crime, such as a drunk driving crashContact your state’s programIt pays after other sources
No insuranceUninsured and self pay patientsAsk for a good faith estimate and check enrollment optionsA crash alone does not open an enrollment window

Each route is explained in its own section below, with sources and limits.

If you only have energy for three things this week, do these. Get free support if you are struggling. Tell your auto insurer about the crash in writing. Then call your health plan or EAP and ask what therapy would cost.

Start with your own health insurance

Call the member services number on your insurance card and ask what your plan pays for therapy and other mental health care. Before you call, find out whether your plan is insured (an insurance company sells the coverage) or self funded (your employer pays claims itself). That decides which protections apply. The checklist near the end of this guide lists questions to ask on the call. Write down the date, the representative’s name and a reference number.

Does your plan have to cover therapy?

  • Marketplace plans (sold through HealthCare.gov or a state marketplace): HealthCare.gov says all of them cover mental health and substance use services, with details that vary by state and plan [1].
  • Individual and small employer plans that are not grandfathered: The Centers for Medicare & Medicaid Services (CMS) says the Affordable Care Act (ACA) requires this coverage [2]. Grandfathered plans existed on March 23, 2010 and may be exempt from some newer rules [3].
  • Short term and similar policies: Get Covered Illinois says short term plans and excepted benefit policies (such as specified disease or dental only coverage) are outside Illinois and federal mental health requirements [4].

What parity means

The federal parity law does not itself require a plan to cover mental health care [2]. But when a plan does, it generally cannot set stricter limits on those benefits than on medical and surgical benefits [2]. Limits include cost sharing (copays, which are flat fees, and coinsurance, your percentage share), visit caps and prior authorization [1, 5]. Prior authorization is the plan’s advance decision that a service is medically necessary (needed to prevent, diagnose or treat an illness, injury or condition under accepted medical standards). It does not guarantee payment [5].

Parity applies to employer plans with more than 50 employees (including self funded plans), nonfederal governmental plans and individual coverage. It reaches smaller employer plans through ACA coverage rules [6].

Rules in flux (as of October 2026)

Federal agencies said on May 15, 2025 that they will not enforce the new parts of a 2024 parity rule until a court case is decided plus 18 more months [7]. In March 2026 they told the court they plan a new proposed rule no later than December 31, 2026 [8]. The parity law itself and the 2013 rule still apply [7]. On September 8, 2026, the Department of Labor named three focus areas for the employer plans it oversees. They are limits that apply only to mental health care, medical necessity review and network access [9].

Finding a therapist your plan will pay for

  • Ask whether a therapist is in network (has a contract with your plan) and get the answer in writing. Federal law says a plan must answer in writing within 1 business day and keep the answer at least 2 years [10]. If you relied on wrong network information from your plan, your cost sharing cannot exceed the in network amount [10].
  • If no in network therapist is available, ask for an in network exception (the term Connecticut’s Insurance Department uses). This is a request to see an out of network therapist at in network cost shares [11]. Rules vary by state. New York, for example, lets members of state regulated plans file an Access Complaint when no in network provider can see them in time (rules issued July 2025) [12].
  • Out of network costs are usually higher. The therapist may bill the gap above the plan’s allowed amount (the most it will pay for a service) [5]. Out of network therapists may ask you to guarantee payment first and need not file claims for you [11].

The Summary of Benefits and Coverage is only a summary, so ask for the full plan document too.

Watch for

  • Self funded plans. New York, Connecticut and Illinois say their protections do not reach self funded employer plans, which follow federal rules [4, 11, 13].
  • Directory listings can be wrong. A 2026 study of one large carrier’s directory in five states found that 12.4% of initial calls to psychiatrists and psychologists led to an appointment [14].
  • Ask for an exception before treatment. Connecticut says some insurers require this. It also says preauthorizing out of network care without an approved exception means out of network cost shares [11].

Your own auto insurance: PIP and medical payments coverage

Start here: ask your own auto insurer, in writing, whether your policy will pay for counseling after the crash. Your policy may pay for crash injuries no matter who caused the crash [15]. But the official pages we reviewed do not say plainly that it pays for therapy for PTSD, anxiety or depression. You have to ask. Details below are as of October 2026 and differ by state.

Two coverages to know

Personal injury protection (PIP) pays for treating injuries to you and your passengers and, in states called no fault, can also cover lost wages and funeral costs [16].

Medical payments coverage (MedPay) pays reasonable health care costs for you and your passengers, regardless of fault [17]. Colorado’s Division of Insurance lists $5,000, says it is included unless you reject it in writing, and says it pays before your health insurance [17].

Does it pay for therapy?

The New Jersey and Colorado insurance department guides do not say whether auto coverage pays for counseling or mental health care [17, 18]. State laws differ:

  • New York: the no fault law lists psychiatric services among covered care, plus a catchall for any other professional health services. It does not use the words psychological or mental health. The basic limit is $50,000 per person [19, 20].
  • Florida: care must start within 14 days of the crash. PIP pays 80 percent of reasonable expenses. The full $10,000 applies only if a physician or certain other clinicians found an emergency medical condition (otherwise $2,500) [21]. Its lists of covered providers do not name psychologists, counselors or mental health providers [21].
  • Michigan, New Jersey and Texas: the laws, as we read them, do not mention mental health and rely on general wording about reasonable, necessary or allowable care [22, 23, 24]. We read these on a legal publishing site that says its copy may not be the newest. Confirm them with your state.

Comparison compiled by Safety Behind the Wheel Foundation

Deadlines that can cost you benefits

StateTime limitDetail
FloridaStart care within 14 daysNeeded for the 80 percent medical benefit [21]
New YorkWritten notice within 30 days of the crashHealth service bills within 45 days of the service. Lost earnings and other expenses within 90 days. Late filing is excused only with written proof of “clear and reasonable justification.” [20, 28]
MichiganLawsuit for PIP benefits generally within 1 yearUnless you gave written notice of injury within that year or the insurer paid benefits. Losses from more than 1 year before you file generally cannot be recovered. As published on a legal site [25].

Details are as of October 2026. Check your state’s current rules.

In New York, medical expenses have no time limit if, within one year of the crash, it is clear that more expenses may follow [19]. Ask your insurer what it needs to see within that first year.

What to ask your insurer

  • Do I have PIP or MedPay, what is the limit, and did anyone reject part of it in writing?
  • Does it pay for counseling or psychotherapy for crash related stress, anxiety or depression, and from which types of providers?
  • Do you need a doctor’s order, referral or report first?
  • If a family member was not physically hurt, does anything cover their counseling?
  • Can you put your answer in writing? If the insurer denies a bill, ask for a written explanation [16].

Watch for

  • Waiting. Short clocks, such as Florida’s 14 days and New York’s 30 days, can cost you benefits [20, 21].
  • Low or rejected limits. In New Jersey, limits run from $15,000 to $250,000 or more. A low limit chosen to save premium can leave little for long term therapy [15]. In Texas, PIP can be rejected in writing and covers expenses incurred within 3 years. The law, as published on a legal site, does not require more than $2,500 per person in total [24, 26, 27].

For questions about your policy, call your state insurance department. For advice about your situation, talk with a licensed attorney in your state. This is general information, not legal advice.

The other driver’s insurance, uninsured drivers and injury claims

Start here: before you settle a claim or sign anything from an insurer, talk with a licensed attorney in your state. Filing deadlines, limits on emotional distress claims and repayment to health plans can differ by state. We could not verify them for this guide. Details below are as of October 2026.

Claims against the other driver

If another driver caused the crash, their bodily injury liability coverage is meant to pay for the injuries they cause [16]. Some states limit lawsuits for pain and suffering to people with a serious injury:

  • New York: you can sue the at fault driver if you have a serious injury as defined in state law [28].
  • New Jersey: if you chose the Limitation on Lawsuit option, you give up the right to sue for pain and suffering unless you have a listed injury. One example is a permanent injury shown by objective medical proof. This option does not limit claims for medical bills and lost wages [18].

Which insurance pays first

It depends on your state. In Colorado, MedPay pays before your health insurance [17]. In New Jersey, the policyholder can choose health insurance as primary (first to pay). Then the health plan’s own rules and costs apply. If that coverage had lapsed, you owe an additional $750 deductible (the amount you pay before coverage starts) [29].

If you have Medicare, no fault and liability insurance pay first for crash related care and Medicare pays second [30, 31]. Medicare may pay while your claim is pending and then be repaid from a settlement. So report your claim to its Benefits Coordination and Recovery Center [32].

If the other driver has no insurance

Check your own coverage first. Uninsured motorist (UM) coverage pays you when an uninsured or hit and run driver hits you. Underinsured motorist (UIM) coverage pays when the at fault driver’s insurance is not enough [16]. No regulator page we read says whether UM or UIM pays for counseling or emotional distress. Ask your insurer.

Without a policy of your own, other routes may exist. In New York, if no policy in your household covers you, you may be able to file with the Motor Vehicle Accident Indemnification Corporation (MVAIC). Its number is (646) 205-7800 [28]. The state’s Department of Financial Services (DFS) says to report the accident to the proper authority within 24 hours and then file promptly, because stringent time limits apply [33]. In New Jersey, a May 2026 state Supreme Court opinion describes PIP benefits paid through the Unsatisfied Claim and Judgment Fund. The fund is now handled by the Property-Liability Insurance Guaranty Association [34]. We could not verify their limits or how to apply. Ask your state insurance department, including whether your state has a similar fund.

When the insurer pushes back

  • Exams. Florida’s PIP law lets the insurer require a mental or physical exam. If you unreasonably refuse or do not appear, it stops owing later PIP benefits [21].
  • Recorded statements. We found no regulator page explaining your rights. Ask an attorney or your state insurance department before agreeing to one.

Keep records

We found no official guide to documenting a psychological injury. A consumer guide reprinted by Tennessee’s insurance department says to keep your policy, letters and receipts. It also says to note the dates of conversations with the insurer’s adjusters, and to collect the accident report number and witness details [35]. Ask your doctor or therapist to put in writing when symptoms began and what care they expect you to need. That is a practical step, not an official rule.

Ask a licensed attorney in your state

  • How long do I have to file a lawsuit?
  • Does my state require a physical injury for an emotional distress claim, and how are counseling bills treated?
  • Does my health plan or Medicare expect repayment from a settlement?

Watch for

  • New Jersey’s PIP limit matters in a lawsuit. On May 6, 2026, the New Jersey Supreme Court decided Murray v. Punina. As we read it, the court held that future medical costs within a person’s PIP limit cannot be recovered from the at fault driver [34]. Ask an attorney how this applies to counseling costs.
  • A complaint is not a ruling. Colorado’s insurance division says it does not decide coverage, though it can check that the insurer followed state law [17].

If you were hurt while working: workers’ compensation

Start here: if you were hurt doing your job, such as driving for your employer, tell your employer about the crash promptly. Ask how to file a workers’ compensation claim. Workers’ compensation is the system that covers injuries at work. State law shapes its rules. We could not verify reporting deadlines. Ask your state’s workers’ compensation agency how long you have. Details below are as of October 2026.

Was it a work crash?

A crash can count when you were hurt doing something connected to your employer’s business. In Texas, the worker must prove this. A regular commute is generally not covered [36]. Exceptions include transportation the employer provides or pays for, a vehicle the employer controls, and travel the employer directs. Even then, you must have been furthering the employer’s business [36]. Texas is the only state whose rules we could verify, so ask your state agency about yours.

Counseling after a physical injury

If you had a physical injury, the claim that matters most is a mental condition that grows out of it (often called “physical mental”). A 2024 peer reviewed review, which focused on first responders, reported that all 50 states cover this type [37]. Two examples:

  • Florida: a mental or nervous injury is covered only with a physical injury that needs medical treatment. It must be shown by clear and convincing evidence from a licensed psychiatrist (psychologists are not named). The physical injury must be the major contributing cause, at least 50 percent of the cause [38].
  • Washington: on an accepted claim, mental health treatment is covered when the insurer has authorized it, the work injury caused or worsened the condition, and records show measurable improvement [39]. Only psychiatrists, psychiatric advanced practice registered nurses and psychologists can do the first evaluation [40].

If you were not physically hurt, your claim is called “mental mental.” The same review counted 40 states that cover it, so 10 do not [37]. Ask your state agency about yours.

Federal employees

Civilian federal employees use a separate system, the Federal Employees’ Compensation Act (FECA). A Congressional Research Service report says the Department of Labor’s Office of Workers’ Compensation Programs (OWCP) runs it [41]. We could not confirm what FECA pays for counseling. Ask OWCP or your agency’s compensation specialist.

Gig and contract drivers

We found no official source on coverage for app based or contract drivers. The federal wage and hour page on misclassifying workers does not mention workers’ compensation [42]. Coverage may depend on how your state classifies your work, so do not assume either way. Ask your state agency. Also ask the company about accident coverage for its drivers.

Watch for

  • Commutes. A trip to or from work is not automatically a work crash [36].
  • Approval first. In Washington, the claim manager decides whether the mental condition is allowed on the claim. The first evaluation usually needs prior approval. Ask before you start care [39].

A licensed attorney can advise on your claim. This is general information, not legal advice.

Public programs: Medicare, Medicaid, CHIP and veterans’ care

If you already have Medicare, Medicaid or VA benefits, therapy after a crash may be covered. Two timing points matter most as of October 2026. Medicaid’s backdated coverage gets shorter for applications made on or after January 1, 2027 [43]. Medicare may ask to be repaid from a crash settlement [32].

Medicare

Part B is the part of Medicare that covers outpatient care, including psychotherapy, psychiatric evaluation, medication management and partial hospitalization [44]. In 2026 you pay a $283 yearly Part B deductible (what you pay before Medicare starts paying). Then you pay 20% of what Medicare approves for each service [44, 45]. Covered clinicians include psychiatrists, clinical psychologists, clinical social workers, marriage and family therapists and mental health counselors [44].

These costs are for Original Medicare. With a Medicare Advantage plan (a private company version of Medicare), ask the plan what you would pay.

Telehealth means a visit by video or phone. As of October 2026, Medicare covers telehealth from anywhere in the U.S., including home, through December 31, 2027, generally at the same cost as in person [46, 47]. After that, CMS says mental health telehealth at home needs an in person visit within 6 months before your first telehealth visit, then every 12 months [47]. If you start at home on or before December 31, 2027, only the 12 month visit applies [47].

Auto and liability insurance pay first. No fault insurance pays for accident related care no matter who caused the crash [48]. Liability insurance pays claims that someone’s carelessness caused harm [48]. For crash related care, these pay first and Medicare pays second [30].

If the other insurer is slow, Medicare may make a conditional payment, which must be repaid when a settlement, judgment or award is paid [32]. Tell Medicare’s Benefits Coordination & Recovery Center (BCRC) about a pending crash claim and about any settlement [32, 48]. CMS lists its number as 1-855-798-2627 [49]. A lawyer or the BCRC can explain your situation.

Medicaid

Medicaid is a public coverage program that each state runs under federal rules. Ask your state Medicaid agency how to apply. The dates below are from federal documents as of October 2026 and could change.

  • Backdated coverage. Medicaid can pay for care you got up to three months before the month you apply, if you were eligible then [50, 51]. For applications made on or after January 1, 2027, that drops to one month for adults 19 to 64 in the expansion group. This group covers income up to 138% of the federal poverty level, in states that expanded Medicaid. For everyone else, it drops to two months [43, 50]. If you think you may qualify, ask your state about applying before that date.
  • Work requirement. States must start by January 1, 2027. Some may start earlier [52, 53]. Expansion adults 19 to 64 must show 80 hours a month of work, community service, a work program or at least half time school, or qualifying income [52, 53]. Exemptions include medically frail adults and parents or caregivers of a child 13 or under [52]. KFF reports that a diagnosis alone is not enough and that the rule does not name concussion, brain injury or PTSD [54].
  • Immigration status. Since October 1, 2026, Medicaid is narrower for some immigrants [53]. Ask your state how it applies.

CHIP and children

CHIP is the Children’s Health Insurance Program. Ask your state Medicaid agency about a child’s coverage. One medical association’s summary says CHIP’s backdated window also drops to two months from January 1, 2027 [51, 55].

For children and young people under 21 in Medicaid, states must provide the medically necessary services that correct or improve the condition, even if adults do not get them [56]. Flat or arbitrary limits, such as fixed caps, are not consistent with this rule [56].

Veterans and military families

The Veterans Crisis Line is open 24/7: dial 988 then press 1, or text 838255 [57]. Its TTY number is 1-800-799-4889 [58]. Family and friends of veterans and service members can use it too. VA enrollment is not needed [57].

Vet Centers offer free, confidential counseling for depression, PTSD and the effects of military sexual trauma to veterans, service members and their families [58]. The free Call Center is 1-877-927-8387, open around the clock [58]. VA health care depends on your service history. Ask the VA whether you qualify and what a mental health visit would cost [59]. This section does not cover TRICARE or Indian Health Service benefits, so ask them directly.

Watch for

  • Hospital outpatient departments may add their own copay or coinsurance on top of the 20% [44].
  • After a settlement, a Conditional Payment Notice gives you 30 calendar days to respond [32]. Without a response, a demand letter follows with no reduction for fees or costs. Interest builds [32].
  • For renewals on or after January 1, 2027, expansion adults renew every six months. States check work rules at renewal [43]. Missing a state notice can cost coverage [43].

Help through work: EAPs, job leave and tax advantaged accounts

Ask your HR or benefits office two questions: does our employer offer an Employee Assistance Program (EAP), and what job protected leave do I have? An EAP is a free, confidential, work based program that offers short term counseling and refers you to other care when you need more [60, 61].

Employee Assistance Programs (EAPs)

An EAP offers assessment, short term counseling, referrals and follow up at no cost to you [60]. The federal program also lists crisis, legal and financial help [62].

Who can use it. Family coverage depends on the employer’s contract [61]. In one 2022 survey of large employers (81 answered this question), 78% covered minor children and 65% covered any household member [63]. Some plans keep access after a job ends: six months at the University of Kansas, one year in Wisconsin [64, 65].

How many sessions. No single number is typical. Published examples of free sessions per issue per year:

Comparison compiled by Safety Behind the Wheel Foundation

Free EAP sessions in published examples

ExampleFree sessions
Massachusetts state program [83]3
Illinois State University [84]5
Wisconsin state program [65, 66]6 or 8 (its own pages differ)
University of Kansas [64]8
Military OneSource [71]up to 12

Examples from published plans, not a national norm.

Confidentiality. EAPs call their services confidential. Employers get program level information, not details about you, unless you sign a release [61]. Limits include legal and safety exceptions, such as threats of harm or abuse reports. They also include reports tied to referrals the employer requires. In one state plan document, billing and program monitoring data are sent to the employer [61, 66, 67, 68]. Ask the EAP what it reports before your first session.

How common are EAPs? We could not verify a current national figure. The latest Bureau of Labor Statistics (BLS) figure we found is 16 years old, from March 2010. At that time, 45% of private industry workers and 73% of state and local government workers had EAP access [69]. We found no EAP figure in BLS’s March 2026 release [70].

Military OneSource offers no cost, confidential nonmedical counseling, up to 12 sessions per issue, around the clock at 800-342-9647. It serves active duty, Guard and Reserve members, immediate family and survivors [71]. Sources differ on how long you stay eligible after leaving service, so call to check [72, 73].

Campus and school help. The latest survey of campus counseling centers we found covers 2018 to 2019. About half had no session limit. But 51.3% referred more clients off campus to manage demand [74].

School help for a child. Ask the school what mental health staff it has and how referrals work.

Job leave and disability pay

FMLA. The Family and Medical Leave Act (FMLA) gives eligible employees up to 12 workweeks of job protected leave in a 12 month period. It covers their own serious health condition or care for a spouse, child or parent [75]. It is generally unpaid [75]. Eligibility takes at least 12 months with a covered employer and 1,250 hours of work in the 12 months before leave. Your worksite must also have 50 or more employees within 75 miles [76].

Mental health conditions can qualify through inpatient care or continuing treatment by a provider. Therapy counts when it is part of that treatment, such as counseling after an initial appointment [76]. Leave can be intermittent (in shorter blocks, such as a few hours a week). Group health benefits continue on the same terms [75].

ADA. Under the Americans with Disabilities Act (ADA), a condition such as PTSD or major depression can qualify if, untreated, it would substantially limit a major life activity such as concentrating [77]. Accommodations can include a schedule built around therapy, telework or, in some cases, unpaid leave [77].

You must ask. An employer may request a provider letter. A general description rather than a diagnosis can be enough [77]. To file a charge (complaint) with the EEOC, the deadline is generally 180 days from the violation, or 300 days where state or local law also applies [77]. Ask the EEOC whether the ADA covers your employer.

State programs. Some states run paid family and medical leave programs that replace part of your wages, not therapy bills [78]. Launch dates have shifted in some states and sources disagree, so check your state agency [78]. Washington’s program can cover a mental condition that meets its serious health condition test [79]. California’s State Disability Insurance covers time off for an illness or injury that is not related to work, physical or mental [80].

Short term and long term disability. These employer plans replace some income when you cannot work. In March 2026, 44% of private industry workers had access to short term disability plans and 37% to long term plans [70]. We could not verify mental health limits. Ask HR how your plan treats mental health conditions and how long benefits last.

Tax advantaged accounts and the medical expense deduction

A health savings account (HSA), health flexible spending account (FSA) and health reimbursement arrangement (HRA, funded only by the employer) pay qualified medical expenses with tax favored money [81]. Unspent health FSA money is generally lost at year end unless the plan offers a grace period or carryover [81]. For tax year 2025 (the latest edition we found), IRS Publication 502 lists psychiatric care, psychologist fees, psychoanalysis and therapy received as medical treatment as deductible medical expenses [82]. That suggests therapy fits these accounts too, but confirm with your plan administrator [81, 82].

You can deduct only the part above 7.5% of adjusted gross income (AGI, a tax return income figure), reported on Schedule A [82]. Costs paid with tax free HSA money, or reimbursed by an FSA, HRA or insurance, do not count [82]. This is published information, not tax advice. A tax professional or the IRS can tell you how it applies to you.

Watch for

  • Free EAP sessions are limited and counted per issue [64, 83, 84]. Ask how your plan defines an issue, when the year resets, and whether one crash counts as one issue or several.
  • FMLA protects your job but is generally unpaid. Its 12 weeks can run at the same time as workers’ compensation or disability benefits [75].
  • In some states, paid leave and job protection are separate tests [78].

Free help you can use today

If you need to talk to someone right now, call or text 988, even if you are not thinking about suicide [85, 86]. If you are in immediate danger, call 911. Details are as of October 2026. Confirm them on each page.

Comparison compiled by Safety Behind the Wheel Foundation

Crisis and information lines

LineHow to reach itCostWhat it does
988 Suicide and Crisis LifelineCall or text 988. Chat at chat.988lifeline.org. Spanish: press 2, or text AYUDA to 988. Deaf or hard of hearing: dial 711, then 988.FreeSupport for anyone in emotional distress, not only suicidal thoughts. Its site says it is open 24/7 [85, 86, 87, 88].
Crisis Text LineText HOME to 741741. Spanish: text HOLA to 741741.Free. Carrier rates may apply.Texting with a trained volunteer counselor, 24/7, about stress, anxiety, grief and more. Counselors are not medical professionals [89, 90].
SAMHSA National Helpline1-800-662-HELP (4357)FreeTreatment referral and information from SAMHSA, a federal mental health and substance use agency. English and Spanish, 24/7, 365 days a year. Page updated March 25, 2026 [91].
NAMI HelpLine1-800-950-NAMI (6264), or text NAMI to 62640Free. Text rates may apply.One on one peer support, information and resource referrals from the National Alliance on Mental Illness (NAMI). No counseling or referrals to individual providers. Monday to Friday, 10:00 a.m. to 10:00 p.m. Eastern Time, closed on federal holidays. Not a crisis line [92].

Details are as of October 2026. Confirm numbers and hours on each line’s own page.

Free peer support

Peer support means talking with people who have been through something similar. It is not professional care.

  • NAMI Connection and Family-to-Family: Connection is a free, peer led group for adults (18 and older) who have experienced symptoms of a mental health condition. Many groups are virtual. Family-to-Family is a free, eight session class for family and friends. NAMI does not describe either as crash specific [93, 94].
  • Depression and Bipolar Support Alliance (DBSA): all groups are free, for people with depression or bipolar disorder, plus groups for friends and family. Online groups are moving to a new platform, ShareWell, finishing the week of November 1 [95].
  • Anxiety and Depression Association of America (ADAA): four free, moderated (overseen by hosts) online communities, open 24/7, including one for people recovering from post traumatic stress disorder (PTSD) and trauma. They are online forums, not live meetings, and do not replace professional care [96].
  • Warmlines: peer run phone lines for emotional support, staffed by volunteers in recovery. They are not crisis lines. NAMI hosts a state by state directory (updated July 14, 2026). Many lines serve only one county or state. Some numbers appear under more than one state, so confirm each listing [97].
  • 211: call 2-1-1 or search 211.org by address, ZIP code or county for local services such as mental health resources and help with healthcare expenses. It refers you. It is not treatment and not a substitute for 911. Ask each service about fees [98, 99].

Crash, trauma and brain injury organizations

These groups offer information, referrals, advocacy and peer support. The pages we reviewed do not describe them paying for therapy [100, 101, 102].

  • MADD (Mothers Against Drunk Driving): free victim services after drunk or drugged driving crashes, including for family and friends. Advocates are available 24/7 at 1-877-623-3435. They explain the legal process, give emotional support, refer you to therapy and help you reach crime victim compensation. The page does not say whether they help other crash victims, so ask [100, 103].
  • Trauma Survivors Network (TSN): a program of the American Trauma Society for people with serious injuries and their families. Joining online is free. Hospital programs include support groups and peer visitors (trained people who have been through recovery). The pages do not say what each offers or costs, so ask. Use the TSN map search or call 800-556-7890 [101, 104, 105, 106].
  • Brain Injury Association of America (BIAA): helpline 1-800-444-6443, 9:00 a.m. to 5:00 p.m. Eastern Time, Monday through Friday. It is free and gives information and referrals only: no diagnoses, legal advice, cash, housing or long term case management. It also lists support groups [102, 107, 108].
  • VA apps: Concussion Coach is for anyone with a concussion or other head injury. PTSD Family Coach is for family of someone with PTSD. Both are free, publicly available iOS and Android apps from the VA National Center for PTSD. Neither replaces professional care [109, 110].

Crime victim compensation

Each state runs its own crime victim compensation program. Rules vary. If your crash involved a crime, such as drunk driving or a hit and run, a program may reimburse counseling. The federal Office for Victims of Crime (OVC) says victims may be eligible for reimbursement of medical services, mental health counseling, lost wages and other crime related costs. Find your state on OVC’s Help in Your State page [111].

  • California covers driving under the influence, hit and run and vehicular manslaughter. Most victims can get up to 40 counseling sessions. The filing window is seven years from the crime, with longer options in some cases [112, 113].
  • Texas (2016 attorney general brochure) lists DWI (driving while intoxicated), intoxication assault and failure to stop and render aid, with a three year filing deadline. Check current rules [114].

Both are payers of last resort: they pay only after other sources, such as health insurance [114, 115]. Because these lists name crimes, a crash with no crime involved may not qualify. Ask your state program.

VictimConnect, run by the National Center for Victims of Crime, is 1-855-4-VICTIM (855-484-2846), by call, text or chat. Specialists give emotional support and refer you to local, state and national organizations. It runs on weekdays. Its page refers you to its website for current hours [116, 117].

Watch for

  • Pressing 1 after dialing 988 goes to the Veterans Crisis Line, which serves veterans, service members and the people who support them [57, 85].
  • SAMHSA’s Disaster Distress Helpline is for distress tied to natural or human caused disasters. Its page does not name car crashes. After a personal crash, start with 988 or Crisis Text Line [118].

Low cost care when money is tight

Ask any clinic one question first: do you have a sliding fee scale, a price that drops when your income is lower?

Community health centers

Health centers funded by HRSA (the federal Health Resources and Services Administration) must run an income based sliding fee discount program. They may not turn anyone away because they cannot pay [119]. At or below 100% of the Federal Poverty Guidelines (a federal income measure), the discount is full, though a small charge may be allowed. Between 100% and 200%, it is partial. Above 200%, there is none [119].

HRSA says some health centers also offer mental health care, so call to confirm. It lists a Find a Health Center tool at findahealthcenter.hrsa.gov [120].

Community clinics and FindTreatment.gov

Certified Community Behavioral Health Clinics (CCBHCs) must meet criteria set by SAMHSA, the federal mental health and substance use agency. Its 2023 criteria slides say a CCBHC cannot deny services because of ability to pay. They also say it must use sliding fee schedules and offer crisis management 24 hours a day [121]. The National Council for Mental Wellbeing, a trade association, runs a CCBHC locator [122]. Ask what a clinic offers for trauma or brain injury.

Your state’s mental health agency website is another place to look. SAMHSA also lists FindTreatment.gov, a locator for treatment of conditions such as post traumatic stress disorder (PTSD) and depression. Ask each clinic about fees [123, 124].

Training clinics

University psychology training clinics offer therapy from graduate students supervised by licensed faculty and doctoral level psychologists [125]. The sources we reviewed did not list fees. Ask about fees, wait times and trauma or brain injury experience.

Open Path and charitable funds

Open Path Psychotherapy Collective is a nonprofit offering lower cost therapy online or in person in the U.S. and Canada. It is for people without health insurance, or whose insurance has inadequate mental health benefits, who cannot afford the market rate. Its home page lists no income limits, so check eligibility details first [126].

As shown on its pages, you pay a one time membership fee of $65. Then you pay $40 to $70 per individual session or $40 to $80 for couples or family. A flat $30 applies with a student intern where available [126, 127]. The pages show U.S. and Canadian dollars side by side. We read the first figure in each pair as U.S. dollars. Confirm on the live page.

The Loveland Therapy Fund serves Black women and nonbinary individuals and funds 4 to 12 sessions. It opens its sign up form quarterly, with a waitlist if closed. Therapists can take time to accept its payment vouchers [128]. Neither page mentions crash survivors [126, 128].

Finding a qualified clinician

ISTSS (International Society for Traumatic Stress Studies) lists member clinicians who choose to participate, searchable by expertise, populations served and languages [129]. EMDRIA lists full members who offer EMDR (eye movement desensitization and reprocessing) [130]. If you also had a brain injury, two directories may help. ABPP (American Board of Professional Psychology) lists board certified specialists, including in rehabilitation psychology. AACN (American Academy of Clinical Neuropsychology) has a search page titled Find a Board Certified Clinical Neuropsychologist [131, 132].

Ask a clinician: Which trauma therapies do you offer, and what training do you have? Do you have experience with brain injury? Do you offer a reduced fee?

The 2023 PTSD guideline from the Departments of Veterans Affairs and Defense recommends Cognitive Processing Therapy, EMDR and Prolonged Exposure [133]. The American Psychological Association’s 2025 PTSD guideline for adults recommends cognitive processing therapy, prolonged exposure therapy and trauma focused cognitive behavioral therapy [134]. The lists differ, so use them as questions to ask, not as treatment advice.

PSYPACT is an agreement among states that lets licensed psychologists, and only psychologists, provide remote therapy or short term in person work across state lines after getting authorization [135]. If a psychologist is in another state, ask whether they hold PSYPACT authorization.

Watch for

  • Sliding fee does not mean free. Not every health center offers mental health care [119, 120].
  • Directory listings are not a skills check. EMDRIA says it does not warrant competence. ISTSS does not say it verifies credentials. Check a license with your state board [129, 130].

If you have no insurance, or are between plans

You may still be able to get coverage. You can also ask for a written price before paying out of pocket.

Sign up after losing coverage

As of October 2026, HealthCare.gov says Open Enrollment (the yearly sign up period) for 2027 coverage runs from November 1 to January 15. It says December 15 is the last day to enroll for coverage that starts January 1 [136]. Outside it, you need a special enrollment period. Losing coverage qualifies. You can report the loss up to 60 days before it happens or pick a plan within 60 days after [137]. Qualifying losses include job based, individual and family member coverage, Medicaid and CHIP [137]. On the federal platform, send proof of the loss within 30 days of picking a plan or your choice stays pending (CMS, March 2026) [138].

COBRA

COBRA lets you keep job based coverage after you lose it, usually for up to 18 months [139]. You have 60 days to choose it, counted from the later of the date coverage ended or the date of your election notice [139]. You usually pay the full premium, up to 102 percent of the plan’s cost according to CMS’s 2022 page [139, 140]. The first payment is due within 45 days after you choose COBRA. Coverage can be backdated to the day employer coverage ended [140].

Premium help (as of October 2026)

Enhanced premium tax credits (extra help with Marketplace premiums) expired at the end of 2025, according to KFF [141]. A KFF analysis reprinted by MedCity News in 2026 said they were not extended [142]. Check HealthCare.gov for anything newer.

Paying yourself: ask for a good faith estimate

If you are uninsured or paying yourself, a provider or facility must give you a written good faith estimate when you schedule or ask for one [143]. Self pay includes people who have insurance but do not want a claim submitted. People in Medicare, Medicaid or TRICARE are not eligible [144].

CMS documents from 2021 and 2023 say the estimate is due within 3 business days if you ask or the visit is 10 or more business days away [144, 145, 146]. It is due within 1 business day if the visit is 3 to 9 business days away [144, 145, 146]. A CMS slide deck says one estimate can cover recurring services for up to 12 months [145]. Ask about weekly therapy. The CMS pages reviewed here do not name therapists, so ask whether your provider gives estimates.

If the final bill is at least $400 more than that provider’s estimate, you can start a federal dispute process within 120 calendar days of the first bill [143, 146]. The No Surprises Help Desk is 1-800-985-3059 [145].

Hospital financial assistance

Tax exempt hospitals must have a written financial assistance policy for emergency and other medically necessary care the hospital facility provides. The policy must say which providers are and are not covered [147]. The IRS pages reviewed here do not say outright that outpatient behavioral health is included. A separately owned practice may not be covered. Ask the billing office which providers the policy lists. Before extraordinary collection actions (such as credit reporting, liens or lawsuits), a hospital must make reasonable efforts to check whether you qualify [148]. It must also wait at least 120 days after the first bill after discharge [148].

Watch for

  • No crash exception. HealthCare.gov’s list of qualifying events does not include a crash or injury. Stopping COBRA on your own or missing payments does not open a special enrollment period [137].
  • An estimate is not a contract. Actual charges may differ [145].

If a claim or visit request is denied

A denial is not the final word, whether it comes after a visit (a claim) or before one (a prior authorization request, meaning a request for advance approval). Read the denial notice, write down the deadline, and appeal. You generally have at least 180 days from receiving the notice to file an internal appeal, which asks your plan to review its own decision. The 180 days run from the notice, not from the date of care [149, 150].

Steps

  1. Read the notice. For employer group plans, it must give the specific reasons, what extra information is needed, and how to appeal [150]. For denials based on medical necessity, it must also give the clinical reasoning or say you can get it free [150].
  2. Ask for your file. Employer plans must give you, free on request, the documents and records relevant to your claim [150]. The Department of Labor said on September 8, 2026 that proprietary clinical guidelines for medical necessity review must be available on request [9].
  3. File the internal appeal. Use the insurer’s form or a letter with your name, claim number and ID number. You can add a letter from your doctor [149]. Plans generally have 30 days to decide if you have not received the service and 60 days if you have [149, 150]. A state Consumer Assistance Program can file for you. CMS says denial notices must name yours [3].
  4. Urgent review is only for cases where waiting could seriously jeopardize your life or ability to regain maximum function [149].
  5. Request external review after a final internal denial. An independent reviewer decides. The insurer must accept the result [151]. It covers denials involving medical judgment, such as medical necessity [151, 152]. It is free through the federal HHS process and costs no more than $25 through an independent reviewer or state process [151]. Plans that are not grandfathered must offer it. The process depends on whether your plan is self funded or insured [150].

Deadlines (as of October 2026)

Federal pages disagree on some numbers. Follow the deadline printed in your denial notice. If you are unsure, file by the earlier date.

Comparison compiled by Safety Behind the Wheel Foundation

Appeal deadlines

StepWhat the pages say
Internal appealAt least 180 days from the notice [149, 150]
Request external review4 months (HealthCare.gov) or generally 60 days (CMS fact sheet) [3, 151]

Follow the deadline printed in your own denial notice.

State rules can differ: if a state’s external review process meets federal standards, insurers there follow it [151].

Who to call

  • Self funded employer plan: the Department of Labor’s benefits agency (EBSA) at 1-866-444-3272, or 7-1-1 if you are deaf, hard of hearing or speech disabled [153, 154].
  • Insured plan (an insurance company sells the coverage): your state insurance department. Find it at content.naic.org/state-insurance-departments [155].
  • Marketplace plan: the Marketplace Call Center at 1-800-318-2596 (TTY 1-855-889-4325), listed as open 24 hours a day, 7 days a week, except holidays [156].

Some plans hold mental health care to stricter rules than other care, such as extra prior authorization or visit caps. To report one, a Department of Labor fact sheet for fiscal year 2022 lists three routes. They are EBSA for self funded employer plans, state insurance departments for insured plans, and CMS for state and local government plans [157]. Check that the routes have not changed.

Watch for

  • Grandfathered plans (those in place on March 23, 2010) may not follow the same appeal rules. Employer plans may require two internal appeals before external review [3].
  • Going to court. You generally must finish the plan’s claims process before suing, so talk to a licensed attorney about legal questions [150].

Questions to ask, by who you are calling

Keep a notebook or a phone note. For every call, write down the date, the name of the person, and a reference number. Ask for answers in writing when you can. If concentration is hard right now, ask a family member to take notes or sit in on the call.

Question checklist from Safety Behind the Wheel Foundation

Your health insurer

  1. Is my plan insured or self funded? Is it grandfathered?
  2. What will I pay for outpatient therapy, in network and out of network? Does the deductible apply? Is there a visit limit?
  3. Which services need prior authorization, such as psychological testing, intensive outpatient programs or partial hospital programs?
  4. Are these services handled under medical or behavioral health benefits, and does that change what I pay?
  5. Is video or phone therapy covered? Do audio only visits count?
  6. Can you confirm in writing whether a specific therapist is in network?
  7. If no in network therapist can see me in time, how do I ask for an exception before I start care?

Your auto insurer

  1. Do I have PIP or MedPay, and what are the limits? Did anyone reject part of it in writing?
  2. Does it pay for counseling or psychotherapy for crash related stress, anxiety or depression? From which types of providers?
  3. What notice and billing deadlines apply, and what do you need from me?
  4. Is there coverage for a family member who was not physically hurt?

Your employer or HR office

  1. Do we have an Employee Assistance Program (EAP)? How many free sessions are there, and is the count per issue, per year, or both?
  2. Can my family use it? What does the EAP report to my employer?
  3. Am I eligible for FMLA leave? Can I take it in shorter blocks for appointments?
  4. Do we have short term or long term disability, and how are mental health conditions treated?
  5. Do we offer a health savings account or flexible spending account?

A therapist or clinic

  1. Do you take my insurance? Are you in network?
  2. What is the fee per session? Do you have a sliding fee scale?
  3. If I am paying myself, can you give me a written good faith estimate for a series of sessions?
  4. Which trauma therapies do you offer, and what training do you have?
  5. Do you have experience with brain injury or concussion?
  6. Do you offer video visits, and are you licensed in my state?

A hospital billing office

  1. Does the hospital have a financial assistance policy, and which providers does it cover?
  2. Does the policy cover outpatient behavioral health delivered by the hospital?
  3. What happens to my account while my application is pending?

A licensed attorney in your state

  1. How long do I have to file a lawsuit?
  2. Does my state require a physical injury for an emotional distress claim, and how are counseling bills treated?
  3. Does my health plan or Medicare expect repayment from a settlement?

Signs you need help soon, and what to do in a crisis

Strong reactions after a serious crash are common. The National Institute of Mental Health (NIMH) says post traumatic stress disorder (PTSD) symptoms usually begin within 3 months of a traumatic event, though they can start later [158]. Symptoms fall into four groups. The first is reliving the event, such as flashbacks, upsetting memories or dreams. The second is avoiding reminders, such as avoiding driving or riding in cars. The third is feeling on edge or easily startled. The fourth is changes in thinking and mood, such as ongoing negative feelings or pulling away from people [158]. NIMH says a diagnosis requires symptoms that last longer than 1 month and interfere with daily life. It says a mental health professional decides whether they meet the criteria [158]. For a loved one, NIMH suggests encouraging them to talk with their provider if symptoms do not improve after 6 to 8 weeks [158].

You do not have to wait for a month, a diagnosis or a claim decision to ask for help. If something feels wrong, tell your doctor or a therapist. Our article Signs you may need emotional help after a serious car crash goes into more detail.

Our recommendation

Recommendation from Safety Behind the Wheel Foundation

Call your health plan and your employer’s EAP this week, and ask for the cost of therapy in writing before your first appointment.

This guide is general information, not legal, insurance, tax or medical advice. Rules change. They differ by state, plan and employer. For advice about your situation, talk with a licensed professional.

Sources and further reading

Numbers in brackets match the list below. Where a page showed no date, none is given. Rules and programs change, so check each page for the current version.

  1. 1HealthCare.gov (HHS/CMS). Mental health & substance abuse coverage. healthcare.gov/…/mental-health-substance-abuse-coverage
  2. 2CMS. The Mental Health Parity and Addiction Equity Act (MHPAEA) (page last modified March 13, 2026). cms.gov/…/mental-health-parity-addiction-equity
  3. 3CMS (CCIIO). Has Your Health Insurer Denied Payment for a Medical Service? You Have a Right to Appeal (page last modified September 10, 2024). cms.gov/…/appeals06152012a
  4. 4Get Covered Illinois (state of Illinois). Mental Health Parity Laws. getcovered.illinois.gov/…/mental-health-parity-laws.html
  5. 5HealthCare.gov (HHS/CMS). SBC Glossary. healthcare.gov/SBC-GLOSSARY
  6. 6CMS. The Mental Health Parity and Addiction Equity Act (MHPAEA) (page last modified March 13, 2026). cms.gov/…/mhpaea_factsheet
  7. 7U.S. Department of Labor, EBSA. Statement regarding enforcement of the final rule on requirements related to MHPAEA (May 15, 2025). dol.gov/…/statement-regarding-enforcement-of-the…
  8. 8U.S. District Court for the District of Columbia (copy hosted by the Georgetown Litigation Tracker). Joint Status Report, ERISA Industry Committee v. HHS (March 30, 2026). litigationtracker.law.georgetown.edu/…/ERISA-INDUSTRY-COMMITTEE-v.-DEPARTMENT…
  9. 9U.S. Department of Labor, EBSA. Field Assistance Bulletin No. 2026-03 (September 8, 2026). dol.gov/…/2026-03
  10. 10Cornell Legal Information Institute. 42 U.S.C. 300gg-115, Protecting patients and improving the accuracy of provider directory information. law.cornell.edu/…/300gg-115
  11. 11Connecticut Insurance Department. Navigating Behavioral Health & Substance Abuse Care with Your Insurance Plan (revised June 2023). portal.ct.gov/…/BehavioralHealthConsumerToolKitpdf.pdf
  12. 12New York State. Your Rights: Access to Behavioral Health Services. ny.gov/your-rights
  13. 13New York State Department of Financial Services. NY DFS mental health and substance use coverage consumer guide. dfs.ny.gov/…/mhsud-coverage-consumer-guide.pdf
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  38. 38Florida Senate. Fla. Stat. 440.093, Mental and nervous injuries. m.flsenate.gov/…/440.093
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  41. 41Congressional Research Service (copy at everycrsreport.com). CRS R42107 (updated March 10, 2025). everycrsreport.com/…/2025-03-10_R42107_80b66981690e46d23e36…
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This article reflects the safety priorities of affordable, timely mental health care and fair coverage for people recovering from serious crashes. It is general education, not legal, insurance, tax or medical advice. Coverage rules vary by state, plan and employer and change over time, so verify details with official sources. For your own situation, contact your health plan, your state insurance department or a licensed professional. Reviewed October 2026.

Cite this article: Safety Behind the Wheel Foundation. “How to pay for psychological help after a serious car crash.” drivewithcare.org, https://drivewithcare.org/pay-for-psychological-help-after-crash/. Reviewed October 2026.

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