Do Both Partners Need Insurance for Couples Therapy?

Seeking insurance coverage for couples therapy presents unique challenges. Unlike individual therapy, which addresses a singular mental health condition, couples therapy focuses on relational dynamics. Insurance reimbursement primarily relies on “medical necessity” criteria. The question of whether one or both partners need insurance often depends on how the therapy is structured and billed.

How Insurance Covers Couples Therapy

Insurance coverage for therapy generally relies on a diagnosable mental health condition. For couples therapy to be covered, one partner usually needs to be designated as the “identified patient” with a specific diagnosis, such as depression or anxiety, that impacts the relationship. While both partners participate in sessions, the therapy is primarily framed as treating the diagnosed condition of the identified patient, with the other partner’s involvement considered supportive. Insurance providers require documentation demonstrating how relationship patterns affect the identified patient’s diagnosed condition and how couples-based interventions are relevant to their treatment.

Using One Partner’s Insurance for Couples Therapy

When only one partner has health insurance, therapy can potentially be covered under that partner’s policy. For this to occur, the insured partner must be the “identified patient” and possess a diagnosable mental health condition. The therapy sessions would then be billed under their insurance, with the non-insured partner participating as a supportive figure in the treatment process.

The non-insured partner may need to provide basic demographic information for administrative purposes, but typically does not require a diagnosis for the claim. However, it is important to recognize that the claim will be submitted under the insured partner’s name and diagnosis, which can have implications for the non-insured partner’s privacy. Deductibles and co-pays, which commonly range from $20 to $75 or more per session, would apply based on the single policy’s terms.

Using Both Partners’ Insurance for Couples Therapy

Even if both partners possess their own health insurance policies, one partner will still generally need to be designated as the “identified patient” for billing purposes. This approach is necessary because insurance typically covers treatment for an individual’s medical necessity, not for the couple as a unit addressing relationship issues without an underlying diagnosis. The therapy sessions would then be billed to the identified patient’s insurance plan.

If both policies could potentially cover the identified patient, the concept of “coordination of benefits” (COB) might come into play. COB rules determine which insurance plan is primary and which is secondary for the identified patient’s claim, preventing duplicate payments. This clarifies the billing order for the single identified patient’s treatment.

Important Considerations Beyond Coverage

Using insurance for couples therapy means a diagnosis and treatment information become part of a medical record, which can impact the identified patient’s privacy. This can be a concern for some individuals, as a mental health diagnosis on a permanent record might affect future insurance applications, such as life insurance, or certain employment opportunities.

Not all couples therapists accept insurance, or they may not be in-network with specific plans, which can limit choices for care. For those who prefer to avoid insurance complexities or if coverage is unavailable, several alternatives exist.

Self-pay, or out-of-pocket payment, offers complete privacy and allows therapists to tailor treatment without insurance company restrictions. Session costs typically range from $100 to $250 per hour, though this can vary by location and therapist.

Many therapists also offer sliding scale fees, which adjust the cost based on a client’s income and ability to pay, making therapy more accessible. Employee Assistance Programs (EAPs), often provided by employers, can also offer a limited number of free and confidential short-term counseling sessions, which may include couples therapy. These programs can be a valuable resource for initial support or assessment without involving insurance.