Couples counseling is expensive. I totally understand why you would want to use your insurance to cover it. But it’s a little more complicated than just handing over your insurance information and co-pay.  When you use your insurance, the insurance company gets to dictate what type of treatment, how long, and who can be involved. It’s bad enough having a therapist intricately involved in your personal life but do you really want an insurance agent looking over notes to decide if you really need counseling?

Required Mental Health Diagnosis

In order to bill insurance, your therapist has to give you a mental health diagnosis. I don’t love this practice. I treat symptoms, the underlying causes, and the dynamics that reinforce them. Diagnoses can be helpful, especially for doctors or to get your kid an IEP, but they also stay in your medical file for the rest of time. So I don’t love diagnosing people and avoid it if I can.

How does this practice of diagnosing work if you’re using insurance for couples counseling? The therapist bills under one person’s insurance. Which means that the therapist diagnoses one person and then has to support treating that diagnosis (not the relationship problems) in the assessment and progress notes. This feels pretty unethical to me. I’m not treating your anxiety or depression. I am working with you and your partner to improve your relationship satisfaction and have the relationship you’ve always wanted.

Couples Counseling: Justifying “Medical Necessity” 

There is a code for couples counseling (90847) which allows “family psychotherapy, conjoint psychotherapy with the patient present.” Many insurance plans do not cover this code for adult patients. If they do cover couples counseling, it is only if there is “medical necessity” which means that the assessment and progress notes need to indicate how couples counseling is treating the diagnosis and why you need the partner present to improve symptoms.

Most people don’t come to couples counseling to treat their anxiety or depression. They come in because of miscommunication, poor conflict resolution, a feeling of disconnect, relationship dissatisfaction, lack of intimacy, or maybe an affair. Insurance companies don’t care about those issues. They care about the diagnosis. Which means I’d have to lie and I don’t like lying.

How Come Other Couples Therapists Take Insurance?

Many people want to use their insurance and, in order to comply with group practice policies and/or to get clients in the door, some therapists will take insurance. It is not financially feasible for everyone to pay out of pocket. So there are therapists who are willing to work within the system. The system of diagnosing one person in the couple and trying to justify medical necessity of having the other person present for treatment of the diagnosis.

I don’t want to compromise my ethics to work within the system so I don’t. Clients that come to see me don’t want the diagnosis and the insurance agent reviewing our progress notes to decide if treatment is necessary and when it should end. I don’t believe in having people in treatment longer than needed. But let’s make this call together and leave the insurance company out of it.

What if I Don’t Care and Want to Use My Insurance?

Fair enough. There are many people who choose this option. There are two ways to use your insurance. One, you can go to an in-network provider. Call the number on the back of your insurance card and find out if you have mental health benefits and if they cover the code “90847” for couples counseling. If they do, you can request a list of “in-network” providers who take your insurance. That’s one option.

Another option, would be to submit for reimbursement for “Out of Network” services. If you want to do this, I can complete a form (with a diagnosis) called a superbill which you can submit to your insurance company for partial reimbursement. You’ll want to ask your insurance company what your out of network benefits are to determine how much they are going to reimburse.