You pay money for insurance benefits each month, but now you are wondering if your insurance will pay for couples’ therapy.
This is a great question. Not all insurance companies or plans will cover couples’ therapy—but some do. 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 plan cover marriage counseling/couples’ therapy? Some insurance companies will cover individual counseling with a family member present or will cover family therapy. It’s important to know how your plan is written.
2. Does it have to be coded a specific way to be covered? This is a follow-up to the previous question. Relationship issues are coded differently than specific diagnoses. Insurance companies typically 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 may not need this option. They are often able to maintain their full schedule by their own advertising and through word of mouth referrals and do not need to settle for a small percentage reimbursement from the insurance companies. 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 that 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. In my past experience, if the 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 marriage therapy retreat, 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.