Couples therapy is a big choice to consider in any relationship.
While it’s important to consider your relationship issues and why you need to seek help, couples are usually plagued by financial questions. Is couples therapy covered by insurance? How do you know if you’re covered?
To clear up some of the confusion, we’ve rounded up some of your options when it comes to dealing with the costs of couples therapy.
How much does couples therapy cost without insurance?
Without insurance, couples therapy or marriage counseling can leave couples quite out-of-pocket!
Couples therapy costs vary depending on the number of sessions, your chosen couple’s therapist, if you live in a higher-cost city, and if you choose to go in-network or out-of-network with your insurance providers.
Depending on your relationship problems, and your own medical necessity, some people can get their insurance to cover marriage counseling. But how does this work when it comes to the cost of couples therapy?
Similar to marriage counseling, insurance plans usually only cover couples therapy under certain strict conditions. For example, if they receive a mental health diagnosis or have an existing mental health condition, both individual therapy and couples therapy can be considered as part of their treatment plan — meaning that it can qualify for insurance coverage.
How to check if couples therapy is covered by insurance
Medical billing codes: Some insurance plans can cover a type of couples therapy, even if it’s not defined as such! In this case, your insurance provider might say they cover couples therapy because you’re allowed to have more than one person in the room with you — even though it’s not technically couples therapy! So the coverage you will be checking is family therapy in this case. Make sure you check your medical billing codes to ensure you don’t get caught out by any hidden costs.
Employer-Sponsored Group Insurance: While couples therapy is usually not covered by your employer’s health insurance plan — it could be covered by the Employee Assistance Program (EAP). It’s best to ask your employer if they have this package before you attend any sessions to ensure that you’re covered. Additionally, you would need to see only the providers who are contracted for your work-specific EAP program.
Medicare: While Medicare covers marriage counseling, Medicare Part B covers approximately 80% of the costs if it’s given by a behavioral health care provider such as a clinical psychologist, psychiatrist, physician, clinical social worker, or specialist. Under this scheme, you’ll only have to deal with the copay costs rather than being hit with the entire bill. This might limit your options in terms of who you have your therapy sessions with, or your list of clinicians, but could make things more affordable in the long run.
Health Insurance: If you or your partner have received a mental health diagnosis, or require mental health treatment, couples therapy could be covered by your individual insurance. Certain insurance providers will offer in-network options at a reduced rate, or you can seek out-of-network providers based on your plan and benefits.
Why wouldn’t couples therapy be covered?
As mentioned above, there are a number of reasons why couples therapy is not covered by insurance. Even though relationship issues are important, they are not seen as mental health or medical issues — meaning your insurance company or health insurance plan does not view it in the same light as other forms of therapy.
In order to receive these insurance benefits, there needs to be an evidence-based reasoning behind the need for couples therapy. Since these issues don’t affect your physical health, you need to be diagnosed with a mental health disorder in order to avail of this kind of counseling services.
Without a mental illness, it’s more difficult to cover counseling costs under insurance. However, even if your insurance plan doesn’t cover your couples therapy, there are other sliding scales that can help reduce your overall costs — and there are other mental health services at your disposal.
If your sessions are covered, they need to be conducted by a licensed provider in your state of residence, not a relationship coach. the provided psychologists or chosen medical professionals.
Ask your healthcare or insurance provider if you have any questions regarding your deductible costs or reimbursement you’re entitled to from relationship counseling. Make sure you ask about family counseling specifically and ask for your CPT code to avoid any additional confusion.
It’s important to do your research in order to find the right therapist for you, and if couples therapy is suited to the relationship issues you’re facing!