You have decided that your relationship needs professional support. You are ready to start couples therapy. And then you check your insurance coverage and discover that it probably will not pay for it.
This is one of the most common and frustrating barriers couples face when they are ready to get help. The short answer is that most insurance plans do not cover couples therapy. The longer answer involves understanding why, knowing the exceptions that sometimes exist, and exploring the options that make couples counseling financially accessible even without insurance coverage.
Why Insurance Usually Does Not Cover Couples Therapy
Federal laws including the Affordable Care Act and the Mental Health Parity and Addiction Equity Act require insurance companies to cover mental health treatment on the same terms as physical health treatment. That sounds like it should include couples therapy, but it does not, because of how coverage is structured.
Insurance covers conditions that carry a medical diagnosis. Depression, anxiety, PTSD, bipolar disorder: these are diagnosable conditions with billing codes, and therapy for them is covered under mental health parity laws. Couples therapy, however, is not classified as treatment for a diagnosable condition. It is treatment for a relationship, and relationships do not have diagnostic codes. Because there is no billable diagnosis associated with “our communication has broken down” or “we cannot stop fighting about the same things,” most insurance plans exclude couples counseling from coverage.
This is not a reflection of how serious or necessary the work is. It is a structural limitation of how insurance categorizes mental health services. The clinical evidence for couples therapy, particularly approaches like Gottman Method and Emotionally Focused Therapy, is strong. Insurance simply has not caught up to that evidence in its coverage policies.
When Insurance Might Cover It
There are situations where insurance may partially cover couples therapy, and they are worth understanding even though they come with caveats.
If one partner has a diagnosable mental health condition that is directly affecting the relationship, such as depression, anxiety, PTSD, or a substance use disorder, some insurance plans will cover therapy sessions billed under that individual’s diagnosis. In clinical terms, this is sometimes called the “identified patient” approach: the sessions are billed as family therapy (CPT code 90847) with the diagnosed partner as the primary patient, even though both partners are in the room.
This approach is legitimate when the diagnosis is accurate and the condition is genuinely affecting the couple’s dynamic, which it often is. However, it is important to understand a consequence that is rarely discussed. If a diagnosis is used to bill insurance for couples therapy and the relationship later ends in divorce, that documented diagnosis can potentially be introduced in custody proceedings or used in other legal contexts. A mental health diagnosis on your insurance record is not confidential from legal discovery in family court. This does not mean you should avoid treatment. It means you should be aware of how the billing works and make an informed decision. If this concern is relevant to your situation, consulting with both your therapist and a family law attorney is a reasonable step.
Check Your Specific Plan
Insurance plans vary significantly, and it is worth checking yours directly rather than assuming couples therapy is not covered. When you call your insurance company, there are several specific things to ask about. Find out whether your plan distinguishes between individual therapy and couples or family therapy in its coverage terms. Ask whether you need to use an in-network provider or whether out-of-network providers are eligible for any reimbursement. Clarify your deductible, your copay or coinsurance rate per session, and whether the plan imposes a limit on the number of sessions covered per year. Ask whether prior authorization is required before beginning therapy. And confirm whether the plan requires you to pay upfront and submit for reimbursement or whether the provider can bill the insurance directly.
Even if full coverage is not available, some plans offer partial out-of-network reimbursement that can meaningfully reduce your per-session cost. At Self Care Impact Counseling, if you are using out-of-network benefits, we can provide the documentation you need for reimbursement. We also partner with Mentaya, a tool that helps you check your out-of-network benefits and estimate your net cost before you start, which for many clients brings the effective per-session rate down to the $40 to $70 range.
Employee Assistance Programs
If your employer offers an Employee Assistance Program, it may cover a limited number of couples therapy sessions at no cost to you. EAPs are designed to provide short-term support for personal challenges that affect job performance and wellbeing, and relationship difficulties fall squarely within that scope.
EAP sessions are confidential and separate from your regular insurance benefits. They typically cover three to six sessions, depending on the program. That is often not enough to complete the work, but it can be enough to get started, establish a relationship with a therapist, and determine whether ongoing couples therapy is worth investing in. Some EAPs also provide referrals to external therapists for continued care after the initial sessions are used.
Check with your HR department or benefits portal to find out whether your employer offers an EAP and what it covers. Many employees do not know this benefit exists.
What Couples Therapy Costs Without Insurance
Without insurance, couples therapy in the Denver metro area typically ranges from $100 to $250 per session, depending on the therapist’s experience level, credentials, and the length of the session.
At Self Care Impact Counseling, our rates range from $100 to $195 per session, with the variation based on clinician experience level. We are able to keep rates lower than many private practices because we operate as a team-based practice rather than a solo practitioner model. That structure lets us share resources, invest in training and clinical supervision, and offer access to skilled therapist candidates and interns at rates that are more accessible. The clinical quality is maintained through weekly supervision and consultation with experienced licensed clinicians, which means you are not just getting the care of one therapist. You are getting the support of a clinical team.
We accept all major credit cards, debit cards, and HSA/FSA cards. Many clients use pre-tax HSA or FSA funds to pay for therapy, which effectively reduces the cost. We are also open to discussing session frequency. Many couples start weekly and shift to every other week as they build skills and stability, which reduces the monthly cost while still maintaining therapeutic momentum.
The Cost of Not Going
It is worth putting the cost of therapy in perspective. The average cost of a divorce in the United States, including legal fees, court costs, and the financial restructuring that follows, is estimated at $15,000 to $30,000 or more. The cost of 12 to 20 sessions of couples therapy, even without insurance, is a fraction of that. And even if the couple ultimately decides to separate, therapy can make that process more constructive by improving communication, reducing conflict, and facilitating better agreements around co-parenting and finances.
Couples therapy is an investment in the relationship that matters most to you. The fact that insurance does not always recognize it as such does not diminish its value. It means you may need to be more intentional about how you access it, and understanding your options is the first step in making that happen.
Couples Counseling in Lakewood and Longmont, Colorado
At Self Care Impact Counseling, we offer couples therapy at our offices in Lakewood and Longmont, as well as online sessions for anyone in Colorado. Our therapists are trained in Gottman Method and Emotionally Focused Therapy, with rates designed to make quality couples counseling accessible.
We invite you to call us at 720-551-4553 for a free 20-minute phone consultation, or try our Find-Your-Therapist tool to get matched with a couples counselor. You can also check your estimated out-of-network reimbursement on our rates page using the Mentaya tool. Reach us anytime through the contact page on our website.
Self Care Impact Counseling envisions a new age of counseling for adolescents, adults, couples and groups that makes a REAL difference with core values of GROWTH | BALANCE | COMPASSION | INNER HARMONY.
About the Author
Alayna Baillod, LCSW, is a Clinical Supervisor and the Owner of Self Care Impact Counseling. She is an EMDRIA Approved EMDR Consultant and EMDR Therapist, extensively trained in Gottman Couples Therapy, Emotion-Focused Therapy (EFT), DBT, Somatic Therapy, Internal Family Systems (IFS), and Attachment Theory. Alayna specializes in couples counseling, EMDR trauma therapy, and codependency recovery. Find your therapist here.
