Does Insurance Cover Couples Counseling

When it comes to couples therapy, insurance generally doesn’t cover it. Federal laws like the Affordable Care Act and the Mental Health Parity and Addiction Equity Act require insurance companies to treat mental health conditions the same as physical health ones, ensuring equitable coverage. However, couples therapy is not typically covered because it isn’t classified as a medical diagnosis. Mental health parity laws only cover conditions with medical diagnoses, excluding marriage counseling.

Be Aware of the Consequences of a Diagnosis

In cases where insurance might cover couples therapy due to a medical diagnosis, it’s important to be aware of potential consequences. If one partner’s diagnosis is used to justify coverage, that diagnosis could later be used against them during a divorce. For instance, a mental health condition like depression or addiction could influence child custody decisions or affect property division. Therefore, while seeking insurance coverage may offer financial relief, it’s crucial to consider how such information might be recorded and interpreted if the relationship ends. Consulting with both your therapist and legal professionals can help you navigate these complexities carefully.

When Might Insurance Cover Couples Therapy?

In certain situations, though, insurance might cover couples therapy if the need for it arises due to a specific mental health condition. For instance, an insurance provider may cover counseling if one partner is dealing with a condition like a sex addiction that impacts the relationship. However, securing insurance coverage can still be challenging.

What to Check in Your Insurance Plan

When reviewing your insurance plan to see if couples therapy is covered, you should confirm if you need to choose an in-network therapist or if out-of-network providers are eligible for reimbursement. Look into your deductible to understand how much you’ll pay out-of-pocket before insurance starts covering costs, and check for any copays or coinsurance rates you’ll need to cover per session.

It’s also essential to see if your plan requires upfront payment with a reimbursement process or if you will be charged directly. Make sure there aren’t strict limits on the number of sessions covered annually or any specific exclusions that might affect therapy. Additionally, verify if prior authorization is needed before starting sessions and whether your employer’s Employee Assistance Program can coordinate with your health plan. Taking these steps will help you avoid surprise expenses and get the most out of your coverage.

 Exploring Employee Assistance Programs (EAPs)

Employee Assistance Programs (EAPs) can be a valuable resource for couples seeking therapy. These programs, typically offered as an employee benefit by many companies, aim to provide support for various personal challenges that can impact job performance and overall well-being. If relationship difficulties arise from more serious concerns like addiction, depression, or other mental health issues, EAPs can often cover a portion of the cost of couples therapy.

EAPs operate confidentially, ensuring that employees and their family members can access necessary help without concern about privacy. They offer short-term counseling services directly or may provide referrals to external professionals for more specialized or long-term support. In the context of couples therapy, EAPs generally focus on addressing issues that affect both partners’ mental health or a significant personal problem that creates stress within the relationship.

 How Much Does Couples Therapy Cost Without Insurance?

Without insurance, couples therapy generally costs between $75 and $200 per session, depending on the therapist’s expertise, location, and reputation. Many therapists also offer sliding-scale fees based on income or discounts for bulk session purchases. While the costs can add up, the potential benefits can be invaluable. Therapy can help save a marriage or, if a couple decides to separate, make the process smoother by facilitating better communication about assets and child custody.

Does Marital Status Affect Insurance Coverage?

If you’re not married but still want to seek couples counseling, insurance policies vary. Some don’t specifically require marriage for coverage, while others do. It’s crucial to verify this with your insurance provider. If not covered, expect the therapist to charge the same rate regardless of marital status.

Family Therapy Loophole

Family therapy can sometimes be covered by insurance through a loophole known as the “identified patient” method. If one partner meets the criteria for a medical diagnosis, therapy sessions can be billed under CPT code 90847 for family therapy. Some insurers, however, only cover therapy if a diagnosed child is part of the sessions.

Most insurance plans only cover conditions classified as medical diagnoses, so it’s essential to reach out to your provider directly to clarify details like deductibles, copays, and exclusions. Even if couples therapy isn’t explicitly covered, a therapist might identify a mental health condition in one partner that is affecting the relationship. In such cases, sessions can be billed under that diagnosis. This workaround allows couples to obtain coverage for therapy by leveraging the medical diagnosis requirements.

Overall, insurance policies vary, so the best approach is to speak with your insurance company and any potential therapists about what’s covered.

Relationship Help in the Denver Area

We invite you to call us at 720-551-4553 for a free 20-minute phone consultation. You can schedule your appointment via phone, email, or the contact page on our website. We offer both in-person and online Couples Counseling. We’re open to whichever option you feel more comfortable with.  We look forward to hearing from you!

Self Care Impact Counseling envisions a new age of counseling for adolescents, adults, couples & groups that makes a REAL difference with core values of GROWTH | BALANCE | COMPASSION | INNER HARMONY.