Insurance coverage for couples’ therapy can vary depending on the insurance company and policy. While some insurance plans may provide coverage for couples’ therapy, it’s important to note that not all insurance plans cover this type of therapy. The best way to know what is covered under your plan is to call the number on the back of your insurance card. There are some specific questions you’ll want to ask:
1. Does my insurance plan cover marriage counseling/couples’ therapy? Some insurance companies will cover individual counseling with a family member present or will cover family therapy. Ask your insurance company if they cover couples therapy.
2. Does it have to be coded a specific way to be covered? Insurance companies typically require a diagnostic code for mental health services to be covered. Relationship issues may be coded differently than specific diagnoses, but they can still be covered under mental health benefits. It’s important to check with your insurance company to see if they require a diagnosis (i.e. depression, PTSD, anxiety, adjustment disorder, etc.).
3. What are my out of network reimbursement benefits? As you are searching for a therapist, you may find that many therapists do not accept insurance. Unfortunately, the way insurance panels work is that therapists agree to take a smaller percentage of their normal fee in exchange for being listed as a provider for an insurance company. For example, a therapist may charge a client $100 per 45-minute session, but the insurance company only agrees to pay the therapist $40 for that time. This may be a necessary option for therapists who are just starting out in practice or who have a hard time keeping their schedule full. Insurance companies can help as a form of “advertising” and send therapists new clients.
Well-seasoned therapists are often able to maintain their full schedule through their own advertising and word of mouth referrals and may not need to rely on insurance panels for client referrals. For this reason, many therapists do not accept insurance.
The good news, however, is that many insurance plans have what are called “out of network benefit reimbursement.” That means you will pay for the session up front, and the insurance company will reimburse you a portion of that fee. This is a great resource when you want to see a therapist who does not accept insurance or who is not covered in-network by your plan. Ask your insurance company specifically what your out of network reimbursement benefits are and what you need to do to file the claims.
4. How many sessions will you cover in one day? This is an especially important question if you are looking into an intensive marriage therapy retreat. Often, when insurance companies will cover couples counseling, they typically will cover one couples session a day and one individual session for each person. In terms of the intensive therapy, that means you can submit claims for three sessions the first day, one session the second day and one session the third day.
5. What length of therapy session will you cover? Again, if you are considering the intensive couples therapy, this is an important question to consider. The reimbursement will look much different for a 90 min session vs. a 45 min. session. Some insurance companies will even cover longer sessions.
As you talk to your insurance company, you will have a greater sense of what your out-of-pocket expenses are for couples counseling.
