Understanding Insurance Coverage for Couples Therapy

Alyssa Cuomo -

Entering the world of health insurance can feel like stepping into a confusing maze. When it comes to something as important as couples therapy, it gets even trickier. Picture this: You and your partner are seeking help, but suddenly you hit a roadblock—your insurance won't cover it unless it's deemed medically necessary. This leaves many scratching their heads, wondering: Shouldn't the health of our relationship be just as important as our physical health?

Good Therapy (2014) notes that although policies such as the Affordable Care Act seek to ensure equitable access to mental health care, couples counseling is frequently left out. Relationship therapy isn't usually regarded as medically required, in contrast to individual mental health difficulties; nevertheless, certain insurers might pay for it if it's connected to a mental health disorder that affects the relationship. Even if you're insured, it's important to know the specifics of your plan because coverage for unmarried partners may differ and be limited. When treating a partner, therapists may charge under that partner's mental health diagnosis; however, insurance policies differ greatly in what they will and will not pay, especially in cases when there is no primary mental health diagnosis.

Barbara Griswold, LMFT (2023) notes that although most insurance plans cover couples and family therapy under specific circumstances, it's crucial to avoid assuming coverage based on other people's experiences. Therapy related to a single family member's diagnosis is typically considered eligible by insurance, as opposed to merely relationship building. Griswold advises therapists to use the correct billing number and select one client as the "identified patient." Overall, it is advised to charge appropriately for the complexity of couples treatment and to discourage incorrect billing practices.

Couples Therapy Inc (n.d.) stresses the importance of navigating insurance intricacies by understanding policy terms and investigating coverage options. They highlight that insurance typically only covers procedures deemed medically necessary, illustrating this with the analogy of cosmetic versus medically necessary rhinoplasty. While some may attempt to find loopholes for insurance coverage, akin to committing insurance fraud, such practices are deemed unethical and illegal. Even if therapists are in-network, insurance may not cover couples therapy unless it's considered medically necessary, often reimbursing less than individual therapy sessions. This poses ethical dilemmas for therapists trained for longer sessions and underscores the need for fair compensation.

It is also important to discuss what this means for the accessibility of therapeutic services. Couples therapy is a privilege for individuals, as not many people can afford to cover the out-of-pocket cost for the service. The financial barrier in therapeutic services disproportionately impacts marginalized communities and can further worsen the disparities in access to mental health care. The requirement for couples therapy to be deemed as medically necessary also restricts accessibility, as insurance companies prioritize individual diagnoses over relationship dynamics. The limited coverage and high costs associated with couples therapy underscore the need for systemic change to ensure equitable access to mental health services for all individuals, regardless of their socioeconomic status or insurance coverage.

To sum up, as a client, it is important to consider the following:

Insurance covers couples and family therapy when certain conditions are met:

  • The therapy supports an individual who has a diagnosis and treatment plan.
  • The individual(s) with a diagnosis are in therapy to address their own needs.
  • The treatment plan recommends family or couples therapy to meet a specific goal related to medical necessity.
  • Sessions usually last 30-45 minutes.

Therapists might choose not to bill insurance or use balance billing for couples therapy if:

  • The therapy goals don't address the medical necessity of one or more partners.
  • The couple wants longer sessions (45-60+ minutes).
  • The therapy involves specific methods that can't be delivered in 30-45 minutes.
  • Ethically, the needs of the couple or family can't be met in a shorter session.
  • The therapy is more about Parent Coaching than addressing the child's needs.

References

Couples Therapy Inc. (n.d.). Does insurance cover couples therapy? Little known ways to absolutely guarantee you'll find out if it does (and alternatives if it doesn't) https://www.couplestherapyinc.com/does-insurance-cover-couples-therapy/

Good Therapy. (2014, July 16). Does insurance cover couples therapy? https://www.goodtherapy.org/blog/faq/does-insurance-cover-couples-therapy#:~:text=Insurance%20equity%20laws%20don

Griswold, B. (2023, September 25). Billing for couples and family therapy. Navigating the Insurance Maze. https://theinsurancemaze.com/articles/couples/