Couples Counseling & Insurance

The Gritty Details

Does Health Insurance Cover Couples Therapy?

Insurance is not always required if you would like to have couples therapy. This is because there are federal laws, the Mental Health Parity and Addiction Equity Act as well as the Affordable Care Act that can be taken into consideration. A person’s insurers must provide coverage for some mental health conditions. In other words, they are required to treat mental health concerns in the same way that they treat physical health concerns. In addition to this, the insurance company must also refrain from excluding people from insurance coverage and refrain from charging high co-pays.

However, many insurance equity laws do not tend to apply when it comes to couples therapy. This is because mental health parity laws always treat mental health conditions as a medical condition. What this means is that couples therapy is not considered to be a requirement as part of a medical diagnosis. In other words, it cannot be compared to any physical health condition.

Some health insurance providers might need to cover couples therapy if the therapy is required as a direct result of a mental health concern. For example, if an individual’s mental health causes them to refuse to communicate with their partner, it can affect their marriage. Unfortunately, it can prove to be hard to get any insurance coverage. Please make sure that you always read and understand the terms and conditions of your insurance coverage.

If current insurance does not cover couples therapy, is there a way for you to add it to your plan?

Your insurance provider may have a few options for you to consider.

Some insurance plans can cover couples therapy, and it can be an additional benefit. Please make sure that you always read your insurance documents so you know what you are covered for. There is always a chance that you might need to reach a deductible before the insurance coverage can be used. Alternatively, you might need to ask to be reimbursed rather than paying a copay. It makes sense for you to understand whether you will need to wait to be reimbursed for your couples therapy.

Please make sure that you know whether you are likely to be reimbursed before you book your first therapy session.

Requirements For Covering Couples Therapy With Insurance

At the time of writing, Kanaloa Counseling & Coaching accepts Aetna, Optum and Cigna umbrella plans for individual therapy. Kanaloa Counseling & Coaching is not able to accept insurance for couples counseling. However, I want to be sure you know your rights and the realities of using insurance should you wish to find a therapist who is taking insurance for couples work.

There are some clear benefits to not having or using health insurance for couples therapy.

You will not need a diagnosis to have couples therapy. This means you won’t need to pay for a diagnosis before you go ahead and have therapy. You could also find that your therapy is a lot more private. This is because you won’t have an insurance company asking for a copy of your case notes. Finally, your therapist can use a range of modalities and treatments in order to help you. This is potentially a good thing. Many insurance companies limit what modalities and treatments therapists can use. Insurance requires individual sessions and this can be hard for both parties who may feel the relationship between the therapist and the couple is more leaning toward one-side. Insurance also only allows for a certain number of sessions. Your concerns and desire for change may not fit into the box that your insurance company has set out.

WHEN LOOKING FOR A THERAPIST WHO ACCEPTS COUPLES UNDER INSURANCE:

Using individual insurance

You will need to make sure that you or your partner’s health insurance covers your sessions. This can help you if you or your partner has a mental health diagnosis. You or your partner could use the individual insurance to cover the counseling as part of your treatment. You will have to be sure that you or your partner has the right type of insurance first. This is to ensure that you know you’re going to be covered for the sessions or you’ll be reimbursed.

If you can use individual insurance, the out-of-pocket costs will not be quite as high. This is because only you or your partner will be held accountable for the copay. This could make it easier for you to keep an eye on your insurance coverage as there may be less paperwork to deal with.

Using out-of-network benefits

The ability to use out-of-network benefits can be very beneficial. This is because it has the chance to offer you a range of therapists to choose from. In addition to this, you could receive a part reimbursement, which could bring the costs down.

How Do I Check If My Insurance Will Cover Costs?

To check if your insurance will cover the costs you need to do the following:

• Set aside 30 minutes to one hour so you can call your insurance company. Be prepared to wait a while for your call to be answered if you call at a busy time.

Please make sure that you have the following information to hand before you make the call:

• A pen and paper

• Your insurance card

• Your name, date of birth, social security number, address, or the cardholder’s details.

What you need to ask. Please ask your insurance provider the following questions:

• If there are any out-of-network benefits for your insurance policy

• If you have a behavioral or mental health policy with any out-of-network benefits

• What the requirements are in order for you to use out-of-network benefits

• If prior authorization is needed for couples therapy

• If a referral is required from your physician

• If you have an out-of-network deductible. If you do, please ask what it is and how much of it has been met. You should also ask your insurance provider what the start date is, based on your network policy. You should also try to find out if your insurance policy covers couples therapy. Please quote this code 90847. Finally, try to find out what percentage of their usual and customary fee is covered.

While this might seem like a lot to ask, the more information you can get, the better informed you will be. This ensures that you know exactly what to expect if you choose to have couples therapy.  

Will any Kind Of Health Insurance Work?

Unfortunately not. As we have already said, many insurance equity laws do not tend to apply when it comes to couples therapy. This is because mental health parity laws always treat mental health conditions as a medical condition. What this means is that couples therapy is not considered to be a requirement as part of a medical diagnosis. In other words, it cannot be compared to any physical health condition.

This is why it is so important that you do your research. If you would like to have couples therapy, you need to know if your insurance will pay for some or all of it.