Is Couples Therapy Covered by Insurance?
One of the most commonly mentioned barriers to seeking mental health services is cost and either lack of insurance coverage or not finding a provider in that takes your insurance. Whether couples therapy is covered by insurance depends on several factors, including the type of insurance you have, the specific policy, and the reason for seeking therapy. Here are some points to consider:
Type of Insurance:
Health insurance: Many health insurance plans provide coverage for mental health services, which can include couples therapy.
Behavioral health insurance: Some insurance plans have a separate component that covers mental health and substance abuse services. Couples Therapy may fall under this category.
Policy Details:
Review your insurance policy or contact your insurance provider to understand the specific coverage and benefits related to mental health services, including couples therapy.
Pay attention to copayments (fixed amount), deductibles and their accumulation, coinsurance (a percentage), and any limitations on the number of sessions or types of therapy covered. The amount that you will pay per session will depend on whether you have a deductible and the accumulation in your out-of-pocket maximum and the contracted rate of your chosen provider.
It is ideal to know before hand what your coverage would be, and to make sure the provider is in fact in-network with your insurance. Note that there are times the umbrella insurance (such as Aetna, Cigna, United Health Care, or Blue Cross Blue Shield) have third party administrators and some may not be eligible for in-network benefits with a specific provider. In most places, the front desk or designated person offers assistance finding this information.
Diagnosis and Medical Necessity:
Some insurance coverage often depends on a diagnosed mental health condition and medical necessity. Couples therapy may be covered if there's a recognized mental health diagnosis for one or both individuals in the relationship.
At times, insurances may require prior authorization for certain diagnoses, such as Autism Spectrum Disorder (ASD).
Licensed Providers:
Insurance typically covers therapy provided by licensed mental health professionals, such as Licensed Marriage and Family Therapists, Licensed Psychologists, Licensed Clinical Social Workers, Licensed Mental Health Counselors, Psychiatric Nurse Practitioners, or Psychiatrists. Some insurances also offer coverage to see a Registered Mental Health Counselor Intern or Registered Social Work Counselor Intern under their credentialed supervisor (the claims will come under the supervisor’s name as the service provider).
In-Network vs. Out-of-Network Providers:
Insurance plans often have a network of preferred providers. In-network providers generally have negotiated rates, which may result in lower out-of-pocket costs for policyholders. Couples therapy with an out-of-network provider might have higher costs. You’d need to contact your insurance to ask about out-of-pocket benefits. Some providers may submit claims directly to insurance even if they are out-of-network, but most may just provide a superbill (basically a receipt showing cost of sessions, dates, your information, and the diagnosis they have assigned). If going through this route, contact your insurance and ask for guidance on the process of submitting your superbills to them and getting reimbursement. Out-of-network benefits typically reimburse a percentage or add the spendings to your out-of-pocket maximum accumulation.
Preauthorization and Referrals:
Some insurance plans may require preauthorization or a referral from a primary care physician before covering mental health services, including couples therapy.
Employee Assistance Programs (EAPs):
Some employers offer Employee Assistance Programs that include counseling services, including couples therapy, as a workplace benefit. These may or may not be linked to your health insurance. It is completely covered by your insurance, no cost to you. It requires prior authorization - at times you may need to call them back once you have scheduled an appointment (such as if you have Aetna EAP). They’d give you an authorization number, let you know how many sessions are approved, and the expiration date. Insurances like Cigna EAP offer the option to request new authorizations once all approved sessions are done. You or the provider’s office would need to call to close the authorization and offer a new presenting problem, they may ask a few questions.
Notes about payment:
It is important to know that most offices have a late cancellation or no-show fee. Cancellation windows are typically 24-48hours. We understand that things happen, but we also need to honor the providers’ time. Some counselors may waive the fee depending on the circumstances and if it is the first time it happens. Note that these sessions will not be covered by insurance and you’ll own the full contracted rate (which varies based on the contract between your insurance and the provider).
It's important to contact your insurance provider directly to confirm coverage for couples therapy and understand the details of your policy. Additionally, consult with the couples therapist to determine if they accept your insurance and can bill it directly on your behalf.
Working with me…
As a Clinical Sexologist providing consultations to individuals and couples, I do not take insurance but offer sliding scale rates if needed. Sliding scales are basically income-based discounts with a specified range. There are many factors at play such as wanting to make the service accessible, having more or less availability, location service is received, individual’s needs, and such… Please refer to the FAQ to get the most up-to-date information about my current sliding scale rates.
Note that I would not provide a superbill for you to submit for out-of-network reimbursement. I do not offer a diagnosis and my services are not covered by insurance. Some clients with insurance choose to work with me due to specialized treatment and difficulty finding in-network providers with similar experience. I am also able to offer services in Spanish, which helps make the process more accessible for those who rather communicate in Spanish, code-switch, or work with someone familiar with cultural issues. It is important to consider the long-term sustainability of choosing paying out-of-pocket vs finding an in-network provider in your area.
Feel free to reach out to inquire about potential rate for your sessions. I can also provide suggestions for couples therapy in Saint Petersburg, Florida that are in-network with Cigna, Cigna EAP, Aetna, Aetna EAP, and United Health Care through Optum. I may have suggestions for other areas or states as well, please let me know what you’re looking for, your insurance, and your location.
Click here if you’d like to contact me.
I am a PhD in Clinical Sexology candidate at Modern Sex Therapy Institutes and have a Master of Science in Educational Psychology. I work with individuals, couples, non-monogamous relationships, and groups in topics related to sexuality, emotional regulation, communication dynamics, and changing behaviors.
