I often have couples tell me that they want to use their insurance for couples therapy or have been to a couple’s therapist before and that therapist billed their insurance. So why don’t we as a practice? Stick with me here as I explain.
Insurance companies require 3 things to pay or reimburse for counseling:
- an identified client
- a mental health diagnosis
- evidence of treatment that directly serves the identified client AND the mental health diagnosis
How insurance works for individuals
MOST of the time, individual therapy is covered by medical insurers because it is simple for the therapist to identify who the client is, assign a diagnosis (assuming there is one that fits the presenting issues), and provide a treatment that is likely to help the diagnosis (for example, Joe attends therapy for generalized anxiety disorder, and the therapist uses cognitive behavioral therapy to treat his generalized anxiety disorder).
This would be an ethical use of insurance, and the therapist would be able to provide documentation that fits with the treatment being provided. When the insurance company audits the client’s file, the therapist can see how that he/she/they provided therapy to the client (Joe) and used established treatment methods (cognitive behavioral therapy) to treat the medical diagnosis (generalized anxiety disorder).
What about insurance for couples therapy?
Providing insurance for couples therapy is totally different. Who is the client? The relationship – both people. Insurance companies don’t yet have a clear way to cope with this. They want to know there is 1 client. They will sometimes reimburse for “family sessions” but they still want to know who the primary client is.
That leads to the second problem: What is the diagnosis? When we work with couples, the only diagnostic issue we treat is “problems in the relationship”. There is a code for this, Z63.0, but insurers do not cover it. Further, let’s say you meet the diagnostic criteria for generalized anxiety disorder. If you are seeing me for couples therapy, then I am not treating you for generalized anxiety disorder. I am treating the problems in your relationship and we will assume that you either see another therapist for your generalized anxiety OR that your anxiety might lessen over time as your relationship improves.
Either way, the treatment I am providing is Emotionally Focused Couples Therapy. It’s a wonderful, evidence-supported treatment method for helping couples; it is not a treatment for individual mental health diagnoses.
So given all that, my documentation of our work together will show that both partners are the clients, we are working on problems in the relationship, and I am using Emotionally Focused Therapy to achieve this. Sadly, I have yet to find an insurer who will pay for that.
Why do other providers offer insurance for couples therapy?
So why did your other therapist bill insurance? Some therapists are billing insurance because they’re not truly doing couples therapy – they are treating you for a diagnosis and your partner happens to be in the sessions with you learning how to help you with your diagnosis. Other therapists have a different understanding of insurance laws and regulations and genuinely believe they are operating within those bounds. And other therapists believe the ends justify the means. They know that couples therapy is necessary and helpful, so they choose a client to diagnose, code sessions as though they are treating that one client, and they assume the insurance company won’t audit their records.
After speaking with insurers and other respected colleagues and trainers in our field, I have concluded that I cannot ethically bill insurance for couples therapy I provide. Other counselors and practice owners might come to different conclusions.
Skill and Training Matter
Finally, a skilled couples therapist will have advanced training and certifications. Being a couples therapist requires a skill set beyond that of a good individual therapist. Many therapists who are in training will accept insurance as they learn the models. By the time you sit with a skilled couples therapist they will have seen thousands of couples, sat in hundreds of hours of training and been supervised by other expert couples therapists.
What are the benefits of paying out of pocket instead of using insurance for couples therapy?
Pros of paying for couples counseling sessions out of pocket:
- No diagnosis is required. Since you’re not going through your health insurance, the therapist does not need to assign a diagnosis to help cover the cost.
- Counseling is private, since there’s no chance of an insurance company asking for case notes.
- Larger pool of therapists to choose from
- Your therapist can use different approaches and modalities in treatment, since they are not limited to those approved by the insurance company.
And so there you have it. The reason why I chose to make The Relationship Center a full-fee practice that accepts limited insurance for couples therapy. If you still have questions, we would love to answer them, because choosing a couples therapist is one of the most important decisions you can make!!