Does insurance cover couples therapy?
A common question for anyone considering therapy (especially these days!) is, "How am I going to pay for this?" Although we still have a long way to go, therapy access is increasing. One silver lining of the COVID-19 pandemic was insurance companies expanding coverage to include telehealth services, which helped many people who were understandably struggling during a challenging time. But what about couples therapy? Does insurance cover sessions focused on the health and quality of your relationship?
The short answer: Most of the time, yes! Thankfully, most insurance companies do provide coverage for couples therapy sessions. Before searching for a couples therapist whom you and your partner both click with (tips about this will be in an upcoming post!), here's what you need to know to understand your plan better.
When submitting a claim, therapists use CPT codes to tell the insurance plan what services were provided. The most commonly used codes for individual therapy are 90837 (for sessions over 53 min long) and 90834 (for a session under 52 minutes long). There are now specific CPT codes utilized for couples therapy too. When checking your benefits, contact your insurance and ask if they provide coverage for CPT code 90847 (family/couple psychotherapy with the patient present). It's also good to ask if they cover CPT code 90846 (family/couple psychotherapy without the patient present). Many couples therapists, myself included like to conduct at least one individual session with each partner in the early stages of treatment to help with assessment, rapport building, and exploring past family history that may be relevant to the current issues in the relationship. It's essential to code this correctly, as individual assessments can be valuable for the ongoing couples' work.
The "patient" referred to in the CPT code is the insurance policyholder. Another important note is that to use insurance to cover any mental health services, there must be a mental health diagnosis on file for the policyholder. Unfortunately, most insurers have not yet gotten on board that relationship issues like lack of communication, frequent conflict, and relationship disconnection can be detrimental enough to require covered treatment. These issues are still regulated to Z-Codes (example list from BCBS here), for which most insurers do not yet provide coverage. However, some plans allow Z-codes to be fully covered, and it's worth checking with your plan to see if they will allow your therapist to submit claims with Z-codes only. For most of us, insurance must deem any therapy sessions we want their help paying for medically necessary. The discussion around a possible diagnosis for couples therapy is a topic that should be covered during the consultation or in the intake session.
Why is this issue of diagnosis so complicated for couples therapists to navigate? Providing proof of medical necessity via diagnosis feels tricky for couples therapists since we are trained to see the relationship as the client, not either of the partners. This outlook is why many therapists, particularly couples therapists, do not accept insurance and will instead directly charge their clients a private pay fee. Seeing one partner as the "identified patient" goes against the way we were trained to see problems, which is more relationally. Both partners play a role in the interaction patterns that are causing the relationship distress, and both can work to change these patterns. We also believe that a mental health issue does not always cause relationship problems and does not require a diagnosis for proper and effective treatment.
Many clients themselves are also uncomfortable with the idea of one of them receiving a diagnosis that remains on record with the insurance company, so they prefer to pay privately for couples therapy. While many private pay therapists offer superbills (an invoice for services provided) to submit to insurance plans for possible reimbursement for the private pay cost, be aware that if you submit a superbill to your plan, your insurance provider may still require the treatment be medically necessary and will want to audit your therapist's documentation.
Despite the ethical concerns of possibly pathologizing relationship issues, many therapists also value making mental health services as accessible as possible to anyone who wants or needs them and, therefore, choose to panel with insurance companies and follow their policies. Others also offer a sliding scale rate (meaning a possible lowered rate) for private pay sessions. If you would like to work with a therapist out of network, it does not hurt to ask if they offer a sliding scale and, if so, what that rate would be.
Please always check in with a prospective therapist about what options they offer their clients to increase access to care. Couples therapy can be a worthwhile investment for your life and your relationship.
