Couples Therapy Insurance Coverage: 5 Ways to Maximize Benefits

Listen to this article

When you’re seeking couples therapy services, cost is understandably a factor you’re considering. As you make decisions about where to go for therapy, you’re probably wondering if insurance will cover the cost. 

Couples therapy insurance coverage is sometimes, but not always, a possibility. Below, we’ll explore all you need to know about this topic. 

We’ll cover whether insurance will cover couple’s therapy, as well as factors that determine coverage. Finally, we’ll provide tips for maximizing your coverage if possible, or seeking other ways to cover the cost of couple’s therapy.

How does insurance coverage apply to couples therapy?

Health insurance plans cover services if they deem them to be medically necessary. If there is a medically necessary reason for couples therapy, insurance may cover the cost of treatment. 

In the case of couples counseling claims, one couple in the marriage is typically identified as the primary client. The therapist will then bill that person’s insurance for services.

For this to work, the person serving as the client typically needs to have a mental health diagnosis that warrants treatment. For instance, if one spouse has depression or PTSD, that person’s insurance may cover the cost of couple’s therapy, since these conditions could be negatively affecting the marriage. 

It’s important to understand that spousal therapy reimbursement doesn’t always happen. Some insurance plans specifically state in their policy documents that they don’t cover marital therapy.

Others will indicate that they only cover the cost of marriage counseling if one partner is being treated for a specific, diagnosable mental health condition. If one spouse does have a mental health disorder, you’ll still need to prove that couple’s therapy is a necessary part of their treatment.

Which types of health insurance typically cover couples therapy?

There are no specific types of health insurance that cover couples therapy. For relationship therapy coverage, one spouse will typically need to be diagnosed with a mental health condition, and insurance will be billed for the cost of their treatment.

If your insurance covers behavioral health services, it may cover the cost of couples therapy if this service is used as part of a treatment plan for a spouse who has a mental health diagnosis. 

The Mental Health Parity and Addiction Equity Act (MHPAEA) generally requires insurance plans for therapy that choose to cover behavioral health services to cover these services to the same extent that medical services are covered.

This means that if your plan covers therapy, it generally will not be more costly than a medical service like an appointment with a doctor to discuss cardiovascular health. However, the law does not require insurance companies to cover behavioral health services.

So, you will need to check with your insurance company to determine if they cover services like therapy.  Insurances can legally choose not to cover therapy, but the good news is that many plans do choose to offer coverage for behavioral health. 

For more information about the need to have a mental health diagnosis for insurance to cover treatment, see the following video:

Which factors influence coverage for couples therapy?

Couples therapy insurance coverage can occur only in specific circumstances. The factors below determine whether couples therapy will be covered:

• Medical necessity

First, your insurance company must determine that couples therapy is medically necessary. Marital problems in and of themselves are not a billable diagnosis. Instead, you’ll likely need to prove that one spouse has a diagnosable mental health condition requiring treatment. 

• Coverage of behavioral health services

If you are looking to use insurance for couples counseling, you’ll need to ensure that your specific plan actually covers behavioral health services. Review your policy documents or contact the customer service line for your insurance provider to determine if this is the case. 

How can you maximize your insurance benefits for couples therapy?

Partner counseling insurance doesn’t typically exist. Health insurance companies cover services that are medically necessary, meaning a person needs to have a legitimate, billable diagnosis for insurance to foot the bill for treatment. 

Unfortunately, couples and marital problems do not constitute a diagnosis. However, couples counseling could be a legitimate treatment for mental health diagnoses. You can maximize insurance benefits for couples therapy by using the following five strategies, keeping in mind the nuances of couples therapy insurance coverage.

1. Seek a mental health diagnosis

If one member of the relationship has a mental health problem like depression or anxiety, it’s important to complete a mental health assessment. If one spouse has a diagnosis, insurance can be billed to cover the cost of their treatment. 

Couples therapy could then become a part of their treatment plan. This approach leverages couples therapy insurance coverage effectively.

2. Bill both spouses’ insurance providers

This isn’t always possible, but if both you and your spouse have a mental health condition, you might be able to bill both spouses’ insurance providers. This can increase the number of sessions that will be covered each year. 

For example, if each insurance provider caps therapy sessions at 12 per year, you can increase the number of covered sessions by using both partners’ insurances. Some sessions could be billed to the first spouse’s insurance, and others to the second spouse’s insurance, maximizing couples therapy insurance coverage.

3. Choose in-network providers

It’s usually much cheaper to see a provider who is in-network with your insurance company. If you’re seeking couples therapy, be sure to choose an in-network provider to best utilize your couples therapy insurance coverage. 

You can typically browse your insurance company’s website to locate providers who are in-network.

4. Talk to your insurance provider 

It’s never fun to be hit with unexpected costs, so it’s helpful to talk to your insurance company before scheduling a couple’s therapy session. Even if one spouse has a mental health condition, your insurance provider may have specific policies related to couple’s sessions. 

Call your insurance provider to inquire about the extent of coverage for this specific service, emphasizing the need for couples therapy insurance coverage.

5. Ask if an individual therapy billing code is appropriate 

Some insurances may not reimburse for couple’s therapy sessions, but they will certainly cover the cost of an individual session. If this is the case with your insurance provider, ask your therapy office if they can use an individual billing code. 

If one spouse has a mental health disorder, it could be argued that they are the primary client, and they are simply bringing a spouse to their individual session to benefit their treatment. 

This can be justified if the spouse with the mental health diagnosis is the one benefiting most from the session. 

The spouse can be seen as a support person, there to learn how to support their partner in their recovery for a mental illness.

FAQs

If you’re looking for information related to couples therapy insurance coverage, the answers to the following common questions provide additional insights. 

• How do I find out if my insurance covers couples therapy? 

To determine if your insurance company covers behavioral health services like therapy, review your policy documents. You can also call your insurance company directly to determine what services are covered. 

Keep in mind that couples counseling will only be covered if it’s medically necessary, which typically occurs when one spouse has a mental health diagnosis.

• Can I use my health savings account (HSA) for couple’s therapy? 

A health savings account is designed to help you cover out-of-pocket costs for medically necessary services. If couples therapy is medically necessary, you may be able to use funds from an HSA to cover out-of-pocket costs. Contact your HSA provider directly with questions.

• What should I do if my insurance denies coverage for couple’s therapy? 

If your insurance company denies couples counseling claims, you have a right to appeal their decision. Your insurance company must tell you why they have denied your claim and inform you of your right to appeal. Contact your insurance company directly if you have questions about the appeal process. 

• Are there affordable couple’s therapy options available without insurance coverage? 

If you cannot obtain relationship therapy coverage through your insurance provider, you have other options available. You can seek treatment at a community mental health center that offers a sliding fee scale based on income. 

Alternatively, you can seek services through an online therapist. Online therapy platforms typically come with flat fees, which can be more affordable than the cost of seeing someone in an office. 

Finally, you may be eligible for short-term couple’s therapy through your workplace Employee Assistance Program (EAP). Contact your human resources department to see if this is an option for you. 

Closing thoughts

Couples therapy insurance coverage may be possible, but things can get a little tricky. If you’re looking for spousal therapy reimbursement, your insurance provider may offer coverage in certain circumstances.

For instance, if one spouse has a mental health diagnosis and couple’s therapy is part of their treatment, insurance may cover the cost of services. 

If you cannot get coverage through your insurance provider, there are other options to make couple’s therapy more accessible. For example, consider an online therapist with an affordable flat fee, or seek services from a company with a sliding fee scale. 

You might be lucky enough to have an EAP through your workplace, which may offer you a limited number of free couples counseling sessions.