Couples counseling can be an effective way for couples to work through their problems and improve their relationship. However, one question that often arises when couples consider seeking therapy is whether insurance will cover the cost of treatment. The answer to this question depends on a few factors.
First, it’s important to note that insurance coverage for couples therapy varies depending on the individual policy and insurance provider. Some insurance plans may cover couples therapy, while others may not. Generally, we have found that most plans cover it, but unfortunately some insurance plans play games with clients and will say they cover “family counseling” but not “couples counseling.” The billing code is exactly the same for both terms and is determined by the American Medical Association NOT the insurance companies. This code is defined as two or more people in the therapy office working on relational issues (Sounds like couples therapy fits to me!) Insurance plans do not have the right to define the codes as this is determined by medical professionals and based on medical necessity. So generally speaking, most plans do cover couples counseling—even if the insurance representative on the phone tells you they don’t.
For couples therapy to be covered by insurance it does need to be deemed medically necessary. This means that there is a diagnosable mental health condition or issue that is being treated through therapy. For example, if one partner in the relationship is struggling with depression or anxiety, couples therapy may be covered if relationship counseling is deemed necessary to help treat their mental health condition. Again its important to note here, that while insurance companies often try to control treatment and how much they are required to pay—they are NOT medical professionals and they do not make the final decision on whether counseling is medically necessary for you—that is the decision of your therapist. A good counselor will help to advocate for you to get the services you need and couples therapy makes a big difference in any mental health challenges.
If you are unsure whether your insurance covers couples therapy, you can check with your insurance provider (Of course remember to ask if “Family counseling” or “CPT code 90847) is covered in your plan to avoid confusing and incorrect answers. If you are interested in seeking couples counseling with a therapist at Threads of Hope, we are happy to help verify benefits for you, to ensure that you have confidence that you won’t have nasty insurance surprises after the fact.
Whether insurance covers that cost of couple therapy or not, there are great benefits to this type of counseling and it may be more affordable than you think. Many offices like ours offer sliding scale rates, payment plans, and even some free services to ensure that couples who need it can find healing in their relationships and greater mental health in general.
April 2023, Jenny Beall, Counselor, Threads of Hope Counseling