Does Insurance Cover Couples Therapy?

Relationships are something to nurture and invest in. We put in so much time when we commit to someone. Our relationship with our partner is such an integral part of our lives, so it only makes sense that we would want to protect it.

There’s no denying the benefits of couples therapy. From improving communication to uncovering the root causes of conflict, couples therapy can strengthen your bond. And couples therapy is just as important for couples who are not actively dealing with relationship problems. Therapy is an effective way to keep big issues at bay, and it can give you the skills you need to handle the issues that will come (because they always do) in a healthy way.

Navigating the world of health insurance is never a walk in the park, but it’s worth considering how it plays into your ability to receive couples therapy.

Why couples therapy?

If you’re in a romantic relationship, it becomes a huge part of your everyday life. Therefore the condition of that relationship will have a big impact on you, from your general mood to your physical health. It can affect your work, as well as your other relationships. When your romantic relationship is going well, it can bring you the utmost joy, unlike anything else in the world. But when things are not so great and you’re facing bumps (or mountains) in the road, the negative effects are significant. You can feel anxious or depressed. Stress from your relationship can increase your blood pressure and impact your sleep. And your relationship problems can overflow to affect other things, like your work or it can burden other people. And if children are involved your relationship issues can cause long-lasting effects.

Some of the benefits couples therapy can offer:

• Safe space for you and your partner to be vulnerable
• Impartial sounding board
• Tools to break unhealthy cycles
• Increased attunement
• More effective communication
• Coping strategies

Most couples seek couples therapy only at a point of distress, but couples therapy is helpful even without an obvious problem present. It can be used to prevent big issues from showing up in the future.

Should you start couples therapy?

You might be ready for couples therapy if any of the following are true:

• You’re revisiting the same argument again and again
• You’re avoiding conversations and pretending everything is perfect
• You have intimacy issues or feel a lack of connection
• You had an experience of betrayal or a loss of trust
• One of you is considering a breakup or divorce

Mental Health and Couples Therapy

A troubled marriage can certainly affect your mental health or worsen any preexisting mental illness, but a “troubled marriage” in and of itself is not considered a mental illness.

Why wouldn’t couples therapy be covered?

Despite the connection to our health, therapy for maintaining your relationship, as in couples therapy, is not viewed the same way other types of therapy are. Therefore, couples therapy is not usually covered by health insurance because it’s not deemed “medically necessary”.

In order for coverage to apply, a mental health diagnosis is necessary. So when it comes to couples therapy, a mental health diagnosis is usually appropriate. This is because “relationship issues” is not considered a mental health diagnosis.

It can be covered

However, there are cases when couples therapy is covered by insurance. If a partner qualifies as experiencing “mental distress” from their relationship and is diagnosed with a condition such as “adjustment disorder”, insurance would be billed. Always check with your insurance provider beforehand.

How to Check If Couples Therapy is Covered

Be wary when an insurance company says that they cover couples counseling because it’s usually misleading. Most likely it is not referring to couples therapy or marriage counseling. Instead, it means that they cover a procedural code for a spouse to be present in therapy.

Check medical billing codes

Most insurance plans will cover more than one person in the room during a therapy session. So, they will tell you that they cover couples counseling because they will allow your spouse to be in the room with you while you receive counseling for your diagnosed mental health disorder. This is known as Procedural Code 90847: “Family psychotherapy, conjoint psychotherapy with the patient present”. While this can be helpful, it is not actually couples therapy or marriage counseling.

To avoid surprise bills, don’t assume you’re covered. Read your individual policy. Call your insurance company and ask specific questions regarding reimbursement. Ask about how your insurance reimburses “z codes”. For example, some insurers may reimburse according to the Diagnostic Code for marriage counseling: Z-63.00.

Common types of health insurance and couples therapy:

Employee Assistance Program

Although marriage counseling is not typically covered by most standard plans, it could be covered by your employer’s Employee Assistance Program (EAP). To see if your plan covers couples therapy, contact your benefits manager.

Medicare

Some good news if you have Medicare coverage… Marriage counseling falls under the category of family counseling and mental health care, so It is covered by Medicare Part B (Medical Insurance). Medicare Part B covers 80 percent of the cost of couples therapy, but it must be provided by a behavioral health care provider such as a psychiatrist, physician, clinical psychologist, clinical social worker, or nurse specialist.

Health Spending Account or Flexible Spending Account

HSAs and FSAs can sometimes work for couples therapy. Ultimately, it will depend on why you’re seeking therapy. So if the provider (therapist or psychiatrist) deems your counseling as “medically necessary”, you can use these funds for treatment. The best rule of thumb is to ask your provider.

Behavioral Counseling

Typically couples seek couples counseling to work on issues that are shared, and that both partners need to work on. The following are two options where you can go to therapy together, but the treatment is focused on only on one person.

“Collateral” Counseling

This could be an option for some couples. If you or your partner has a severe disorder impacting your relationships, such as alcoholism or bipolar disorder, there is a type of therapy that could be covered. However, this is not the same as couples therapy. If your spouse or partner has a disorder they are being treated for, you could attend therapy with or without them, and it would be billed under your partner’s insurance. Different from marriage counseling, the purpose of this therapy would be to learn more about their disorder. A “collateral” is essentially a “helper”. The focus of the therapy is centered around you helping your partner manage their symptoms. This is a type of treatment and is much less about the couple.

This can be effective for some couples. The collateral partner can gain a better understanding of their partner, and that can improve the relationship.

Coverage through one partner’s individual coverage

If you or your partner have a mental health diagnosis you may be able to attend their individual therapy sessions with them. For example, if you (or your partner) are already receiving treatment for an anxiety disorder, your partner could accompany you with consent from the therapist. Similar to being collateral, you would be more of a listener than an active participant.

How Much Does Marriage Counseling Cost Without Insurance?

Without insurance, most couples pay between $100-$250 per session (about an hour), with sessions typically occurring weekly. Some therapists offer sliding-scale fees based on income, discounts for buying multiple sessions, or even payment plans.

Don’t let cost hold you back from getting the help you need. The Couples Center offers sliding scale options with therapists who offer counseling at a reduced hourly rate. There are also weekend workshops that are more affordable than weekly counseling.

Is Couples Therapy Worth the Investment?

While the cost of couples therapy is nothing to shrug at, it’s hard to quantify the immense benefits it can bring. An unhappy relationship can have damaging effects on all aspects of your life, as well as negatively impacting people outside the relationship. Things don’t tend to get better on their own. Problems tend to boil up unless an intervention like therapy is introduced.

The benefits from couples therapy can cross over to improve your non-romantic relationships too. Therapy has the ability to save a marriage, not to mention saving you from paying the astronomical cost of divorce.

A pro of paying out of pocket is that you’re not limited to a small list of therapists. So you’re better able to find a therapist that fits your needs.

Couples therapy is not just a financial investment. Besides the money, it requires time and a lot of work. But the commitment to couples therapy will pay off tenfold by improving your relationship, happiness, and overall well-being.