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This article aims to teach you how to utilize a practical framework to advocate for the support you need from coaches and other support providers;
January 30, 2022
Does Insurance Cover Couples Therapy? What Do You Do If It Doesn’t?
Couples therapy is a great way to restore a relationship. If you and your partner are experiencing problems and looking to work through them, it could be just the thing to help fix it. The problem is, most insurance companies will not cover couples or marriage counseling. This is because “relationship problems” are not technically a mental health diagnosis, so your health insurance is not liable to pay for this kind of therapy.
However, do not let this stop you from receiving relationship guidance. There are many ways to use your insurance benefits to cover the cost of couples counseling and get the help you and your partner need.
Will My Insurance Pay For Counseling Services?
When it comes to any conversation about insurance, we always suggest that you check your specific health insurance plan. If you and your partner have children, family counseling becomes an important part of the treatment process. Successful sessions help families to function in healthier ways, as well as communicate better and lower any possible negative impacts of spousal fights.
Call your health insurance provider and ask about your mental health benefits. If they cover them, ask about the follow:
- How many sessions insurance will cover;
- What your copay will be;
- If there are any deductibles;
- Will you need approval from a physician to begin mental health counseling;
- How much does your plan cover for an in-network vs. out-of-network provider.
If you go into the conversation having some background it will make it much easier. Insurance may not cover specific couples counseling, but if you have mental health benefits, that can be used to engage in other kinds of therapy.
What Should I Ask My Counselor?
Once you find out this information from your insurance provider, you will know if your specific plan will cover family or couples counseling sessions. Do not forget to communicate with your provider of mental health services. Some important questions to ask could be:
- Do you have to pay them up front and then receive a reimbursement from your insurance company?
- Will they perform the insurance paperwork?
- Are they in your insurance company’s network?
- Do they have any sliding-scale options?
- Do they have any other out-of-pocket payment options?
All of these questions will make the process of starting couples counseling significantly easier. When you find a counselor that works for you, make sure they check all of these boxes so you and your partner get the most out of your therapy journey.
Your Insurance Will Not Cover Couples Counseling, Now What?
If your insurance does not have any of these benefits, do not panic. There are still ways to use the mental health benefits you do have to get help for you and your partner. Check out these 5 tips:
1. Have one partner use his or her individual insurance to cover sessions.
If you and your partner are given a mental health diagnosis, couples sessions could be covered as part of individual treatment. If you are experiencing anxiety or depression, you could use your individual insurance plan to cover couples counseling as part of the larger treatment plan.
This will make your out-of-pocket costs much lower since you will just be responsible for a copay. However, one of you must meet the requirements for a mental health diagnosis. This does not work if both members of the couple are in perfect mental health.
2. Utilize out-of-network benefits.
Out-of-network benefits, if you have them, can be a major perk of your insurance plan. Your pool of therapist options expands significantly. You may be able to apply these benefits towards couples counseling.
You will receive a partial reimbursement for sessions, which is better than having no coverage at all. However, you will not be saving as much as you would with an in-network provider. Consider what you and your partner are willing to pay for sessions and have a conversation about it.
3. Pay out of pocket.
If you feel like you have tried everything and no in-network providers work out and you do not have out-of-network benefits, you may prefer paying out of pocket for sessions. This means you and your partner will be fully responsible for all session fees and will not receive coverage by your insurance plan.
The pro of this is that there is no diagnosis required since you are not going through health insurance. Your therapist will be able to begin treating you as soon as you and your partner are ready. Although, this is the most expensive of the options for couples counseling. If price is a concern but this is the way you want to go about it, ask your therapist about sliding scales.
4. Ask the therapist if he or she can bill under ‘family sessions’.
You or your partner will use his or her individual insurance to cover sessions costs, but instead of ‘individual sessions’, sessions will be billed as ‘family sessions’. This is another way of using your benefits to your advantage.
When you use family sessions, your out-of-pocket expenses are lower since you will only be responsible for a copay. However, once again, you or your partner will need to be diagnosed with a mental health condition to qualify for coverage.
5. Alternate covering sessions.
Here, you and your partner are using your health insurance to cover treatment costs. This time, you and your partner would both use the benefits of your individual plans.
The length of your treatment will likely be longer since you can move forward with your treatment after your personal therapy allowance runs out. Your out-of-pocket costs will also be lower since you are going through insurance. However, in this instance, you will both need a mental health diagnosis in order to qualify for coverage.
A Word From Mental Treat
No matter what option works best for you and your partner, receiving help is the most important step. What goes on in our personal relationships can really affect our well-being and mental health. Couples counseling is a great way to cope and move forward. Continue to educate yourself about payment options and what yours and your partner’s insurance companies will cover.
If you are ready to begin your search for a couples counselor, please check out our platform. Mental Treat has a variety of qualified, licensed professionals who specify in all different types of treatment. Our platform also utilizes filters so you can find the therapist who fits all of you and your partner’s needs. We wish you the best of luck in this process. Take care, and be well.
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