Does Health Insurance Cover Couples Therapy?

Couples therapy helps partners address challenges and strengthen their connection. A common question is whether health insurance covers these sessions. The answer is not a simple yes or no, as various factors influence coverage.

Understanding Coverage Limitations

Health insurance typically covers treatments deemed “medically necessary,” meaning the service must address a diagnosed mental or physical health condition. For couples therapy to be covered, one partner usually needs a diagnosable mental health condition that is impacting the relationship. The therapy is then framed as treating the individual’s condition, with the partner’s involvement considered supportive to that treatment plan.

Insurance companies generally do not cover therapy solely for general relationship issues, communication problems, or personal growth without an underlying clinical diagnosis. Coverage often depends on linking couples therapy to a specific mental health diagnosis of one partner.

Therapists often bill couples therapy sessions under the individual’s diagnosis, even when both partners are present. Common Procedural Terminology (CPT) code 90847 is used for family or couples therapy when the identified patient is present. CPT code 90846 is used for sessions where the partner or family member attends without the identified patient, primarily to support the individual’s care.

For coverage, the therapist must document how the couples therapy directly relates to improving the diagnosed condition of the identified patient. This ensures the treatment is justified as medically necessary, aligning with insurance requirements. Without this documented link, plans are unlikely to provide reimbursement.

Steps to Confirm Coverage and Find Providers

To determine your specific coverage for couples therapy, contact your insurance provider directly. You can usually find the customer service phone number on your insurance card or by logging into your online member portal.

When speaking with your insurer, ask specific questions to clarify your benefits. Inquire whether your plan covers mental health services for outpatient therapy and if couples therapy is specifically covered, particularly when one partner has a mental health diagnosis. Ask about your deductible, how much of it has been met, and your co-pay or co-insurance for both in-network and out-of-network providers.

Also ask whether a referral from a primary care physician is required for mental health services, especially for couples therapy. Inquire about any limits on the number of sessions covered annually. Ask which CPT codes, such as 90847 (family or couples therapy with the patient present) or 90846 (without the patient present), are covered under your plan and for what conditions.

To find a suitable therapist who accepts your insurance, check your insurance company’s website for a directory of in-network providers. Online directories, such as Headway or Alma, allow you to filter therapists by insurance plans they accept, location, and specialization. Verify a therapist’s insurance acceptance directly with their office before your first appointment.

Financial Considerations and Alternatives

Understanding the financial terms of your health insurance plan is important when considering couples therapy. A deductible is the amount you must pay out-of-pocket for covered services before your insurance begins to pay. After meeting your deductible, you may then pay a co-pay, which is a fixed amount for each session. Alternatively, your plan might require co-insurance, a percentage of the total cost of the service that you are responsible for. These amounts contribute to your overall out-of-pocket maximum, which is the most you will pay in a policy year.

If insurance coverage is limited or unavailable, several alternatives can help make couples therapy more affordable. Many therapists offer sliding scale fees, adjusting their rates based on a client’s income and ability to pay.

Employee Assistance Programs (EAPs) are another valuable resource, often provided by employers as part of a benefits package. EAPs typically offer a limited number of free counseling sessions, which can sometimes include couples therapy or provide referrals to other services. These programs are confidential.

Community mental health centers and university training programs often provide lower-cost therapy options. Community centers may offer services on a sliding fee scale or even free of charge for eligible individuals. University psychology or counseling departments frequently operate clinics where graduate students provide therapy under the supervision of licensed professionals, offering reduced rates.

Additionally, Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) can be utilized for qualified medical expenses, including therapy. These accounts allow you to set aside pre-tax money to pay for healthcare costs. While general marriage counseling may not always qualify, therapy for a diagnosed mental health condition often does.