Does Insurance Cover Couples Therapy?

If you have health insurance, it is important to understand what your benefits cover, what types of healthcare are offered to you, and where you can go to get help when you need it. Some insurance plans cover therapy, but it may be hard to understand which types of therapy are covered, how many sessions you can go to each year, and if you will be covered beyond a diagnosis. If you find yourself at a point where you are considering couples therapy, your insurance may cover part of the cost, but this is not always the case. Below, several therapists explain how insurance companies often define their coverage for mental health services such as couples therapy:

McNulty-KateKate McNulty, LCSW: Your insurance may cover some of the cost of therapy if family therapy is a benefit on your plan. Billing for therapy sessions beyond one-on-one treatment can be a source of confusion for some therapists. Billing advice from experts in the field indicates that it is entirely legitimate to bill for family therapy if the people in therapy identify as a family unit. Nevertheless, this does require that billing is in the name of one person as the “identified patient.”

Health insurance coverage is intended to address costs associated with managing the symptoms of a condition, illness, or disorder, so one person must meet criteria for a diagnosis in the DSM, the Diagnostic and Statistical Manual of Mental Disorders used by all credentialed mental health practitioners.

Some insurance companies are beginning to cover family therapy only for situations involving treatment of a child with a diagnosis, and will not cover therapy unless a child is present at the treatment session.

If you’re considering using insurance to pay for therapy as a couple, you may want to call your insurer yourself and make sure you understand your benefits. Have your insurance card ready and all numbers the representative may need to locate your plan details. Ask about a deductible, co-pay, and exclusions; you can inquire specifically about “CPT code 90847,” which is used for family therapy.

Leviton-SusanSusan J. Leviton, MA, LMFT: Insurance plans vary a great deal, now more than ever. However, most insurance plans will only cover “medical” illness and therefore do not pay benefits for couples therapy. That being said, you should contact your insurance company directly, using their phone number for mental health benefits, and ask them if you are covered for couples therapy. Be sure to ask for details about in-network versus out-of-network coverage.

Even if your insurance company says you are not covered, your therapist may find in the course of treatment that one of the partners has a mental health condition, such as severe depression, that is affecting the relationship and they may justifiably bill under that condition. Again, the best way to be sure is to talk to your insurance company and to discuss it with each therapist you contact.

Bartlett-JonathanJonathan Bartlett, MA, MFT: Every insurance policy comes with its own limits. Often, the number of sessions covered (if any) is established based on a diagnosis of the insured person. If a primary mental health diagnosis has been ruled out, “Partner Relational Problem” is a diagnosis often used for couples facing the natural stresses of relationship. If covered at all, it is often limited to 10 sessions.

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  • Lucas

    Lucas

    October 26th, 2015 at 5:39 AM

    how can I find out if I am covered for couples therapy

  • Noel

    Noel

    January 19th, 2016 at 12:02 PM

    I had no idea that insurance could cover some of the costs of therapy. I’m thinking that my family could really benefit from some marriage and family counseling in order to help us communicate better. Since we definitely qualify as a family unit, I’ll identify myself as the patient. Hopefully we can work it out with my insurance; I’ll give them a call like you suggest. Thank you for the information!

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