Seeking couples counseling is a great, proactive step towards resolving all kinds of relationship problems. Unfortunately, health insurance doesn’t technically cover couples or marriage counseling, because “relationship issues” in itself is not a mental health diagnosis (which is a requirement for health insurance to pay for therapy).
But don't let that stop you from getting relationship guidance! There are creative ways to use your insurance benefits to cover the cost of couples counseling.
Here are five possible ways to use your insurance for couples counseling, as well as considerations, pros, and cons to each scenario:
1. Use one partner’s individual insurance to cover sessions
Couples sessions can be covered as part of individual treatment if you, or your partner, are given a mental health diagnosis.
Let's say, for example, you're experiencing symptoms of a mental health condition – like depression, anxiety, or adjustment disorder. You'd use your individual insurance to cover couples counseling as part of your treatment plan.
Pros of using individual coverage to pay for couples counseling:
- Your out-of-pocket costs are much lower, since (assuming you've met your deductible), you’re only responsible for the copay. As with all in-network therapy, majority of session costs are paid by your insurance company.
- It may be easier to keep track of your coverage if it’s all in one place. This is especially true when compared to using out-of-network benefits, a process that requires additional paperwork.
Cons of using individual coverage to pay for couples counseling:
- There is potential liability if you do decide to divorce and/or end up in the courtroom. Paperwork for the individual whose diagnosis was used for insurance coverage may be shared with the court – and could potentially be used as leverage (e.g., for child custody).
- One of you will need to meet the criteria for a mental health diagnosis in order to qualify for coverage. You may not have any symptoms if it is a straightforward issue (e.g., one of you had an affair; both of you want to improve your sex life).
- Your health insurance may only cover for shorter and fewer therapy sessions. Insurance companies can dictate how long sessions run, and how many sessions they will cover. It can be very hard to get approval to extend after that preset amount.
- You may only be covered for certain types of couples therapy approaches. Insurance companies usually only cover brief, evidence-based models, but there may be another model or approach that the therapist finds more beneficial for your particular treatment plan.
- Counseling is less private when using health insurance, as a medical diagnosis is recorded. Counseling records are less private when going through insurance, since companies can require proof of the diagnosis through case notes before continuing coverage.
- The pool of therapists you’re able to choose from is smaller. If you search within your insurance network, you will have a smaller pool of providers to choose from, especially as many in-network therapists are fully booked.
2. Alternate covering sessions with your partner, using your individual insurance plans
As with scenario #1 above, you are using health insurance for treatment coverage. In this case, however, both you and your partner are using the benefits of your individual plans.
Pros of alternating your individual insurance plans to pay for couples counseling:
- Your length of treatment is likely longer, since you can move forward with treatment after your personal therapy allowance runs out.
- Your out-of-pocket costs are lower, since you’re only responsible for each of your copayments.
- You both are liable for future scenarios in court if you end up separating.
Cons of alternating your individual insurance plans to pay for couples counseling:
- You both will need a mental health diagnosis in order to qualify for insurance coverage.
As with scenario #1 above, there are insurance-specific downsides to using coverage for couples counseling, including:
- The therapy type is often dictated by the insurance company.
- Your health insurance may only cover shorter, and fewer, therapy sessions.
- You have fewer options of therapists available. In addition to having an already limited pool of in-network therapists, some therapists may not be willing or able to work with both of you.
3. Ask the therapist to bill as "family sessions" under one partner's insurance
In this scenario, either you or your partner uses individual insurance to cover the cost of therapy – but rather than individual sessions, your sessions are billed as family sessions.
Pros of using your "family sessions" code for couples counseling:
- Your out-of-pocket costs are lower, since you're only responsible for the copay.
Cons of using your "family sessions" code for couples counseling:
The disadvantages to this option are the same as #1 outlined below, namely:
- One of you will need to meet the criteria for a mental health diagnosis in order to qualify for coverage.
As with scenario #1 (and #2) above, there are insurance-specific downsides to using coverage for couples counseling, including:
- There is potential liability if you do decide to divorce and/or end up in the courtroom.
- Your health insurance may only cover shorter and fewer therapy sessions.
- The type of therapy is often dictated by the insurance company
- Counseling is less private, since insurance companies can require proof of the diagnosis through case notes.
- The pool of therapists you’re able to choose from is smaller.
4. Use your (and/or your partner's) out-of-network benefits
Out-of-network benefits can be a major perk, since it often significantly expands your pool of therapist options. If either you or your partner have out-of-network benefits, you may be apply to apply them towards couples counseling, too.
Pros of using out-of-network benefits for couples counseling:
- You will receive partial reimbursement, which is more economical than no coverage at all.
- You'll have a larger pool of therapists available, since you're not limited to just in-network providers.
Cons of using out-of-network benefits for couples counseling:
- Partial reimbursement will typically not, ultimately, save you as much money as using an in-network option would. You will also be responsible for paying the full cost of the session up front (and your insurance company will mail you a check for reimbursement later). However, with some very generous PPO plans, the difference between an in-network copay and out-of-network reimbursement is very small!
- You may not be eligible for session reimbursement if your insurance plan does not have out of network coverage, for example, if you have an HMO Plan.
- Insurance company can still require proof of the diagnosis through case notes, which has the same potential ramifications as noted above in numbers 1-3.
It's often helpful to call your insurance company once you have found an out-of-network therapist to make sure you fully understand your coverage. Here’s a guide to using out-of-network benefits.
5. Skip insurance, and pay for couples counseling entirely out of pocket
If you aren't able to find a therapist who's in-network with either of your insurance plans, don’t have out-of-network benefits, or prefer to keep the content of your sessions entirely private, you may prefer to pay out of pocket altogether. This means you pay the full couples session fee at the time of your appointment and don’t seek coverage by your health insurance plan.
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 more private, since there's no chance of an insurance company asking for case notes.
- Larger pool of therapists to choose from, since the number of therapists who are in-network with your insurance(s) may be limited.
- Your therapist can use different approaches and modalities in treatment, since they are not limited to those approved by the insurance company.
Cons of paying for couples counseling sessions out of pocket:
- Treatment is more expensive, as you have to cover the sessions completely. (If price is a concern, you can ask the therapist if they’re able to offer a sliding scale, or reduced rate based on your income.)
You may have to make a few extra calls to your insurance company, or pay more than you initially expected, to get couples counseling. But at the end of the day, you've made an important and mutual decision to work on your relationship – so don't let insurance limitations keep you from seeking help!