Is Marriage Therapy Covered by Insurance?
Navigate insurance options for marriage therapy. Understand coverage details, verify your policy, and discover alternative payment solutions for couples counseling.
Marriage therapy can be a valuable resource for couples navigating relationship challenges, providing tools and strategies to improve communication and resolve conflict. A common concern for many seeking this support is understanding how health insurance might cover the costs involved. While coverage can be complex, many avenues exist for individuals to access marriage therapy services.
Understanding Mental Health Coverage
Health insurance plans generally cover mental health services, often due to federal regulations. The Mental Health Parity and Addiction Equity Act (MHPAEA) requires most health plans to cover mental health and substance use disorder services no more restrictively than medical and surgical benefits. This means that financial requirements like co-payments and deductibles, along with treatment limits, should be comparable for both mental and physical health care.
Coverage for mental health services hinges on “medical necessity.” This means the service must be clinically appropriate and needed to treat a diagnosable mental health condition. Insurance companies assess medical necessity based on a diagnosis, the impairments resulting from it, and the interventions provided to alleviate symptoms and improve functioning. If a service is deemed medically necessary, the insurer will typically cover it.
How Marriage Therapy is Covered
Marriage therapy, or couples counseling, is often covered by health insurance under specific conditions. Insurance requires one partner to be identified as the “identified patient” (IP) with a diagnosable mental health condition for coverage to apply. The therapy sessions must then be considered a necessary part of that individual’s treatment plan. This means that the goal of the therapy cannot solely be relationship enhancement or communication skills improvement if insurance is to cover it.
Common CPT codes for family or couples therapy include 90847 and 90846. CPT code 90847 is used when the identified patient is present in the session. CPT code 90846 is used when the identified patient is not present, meaning the therapist is meeting with other family members or a partner to support the IP’s treatment. These codes reflect a 50-minute session, and the session is tied to the identified patient’s diagnosis.
Steps to Verify Your Coverage
Understanding your specific insurance benefits for marriage therapy requires direct communication with your insurance provider. You can find your insurance company’s phone number on the back of your insurance card. Before calling, gather essential information such as your member ID number and the full name of the policy subscriber.
When you contact your insurer, ask specific questions to clarify your benefits:
Mental health benefits, including coverage for couples or family therapy and specific CPT codes (e.g., 90847, 90846).
Your deductible amount, how much has been met, and co-pay or co-insurance amounts for mental health services.
Any requirements like pre-authorization or referrals.
Availability of out-of-network benefits if choosing a non-contracted therapist.
Request the representative’s name and a reference number, and consider asking for information in writing.
Exploring Payment Alternatives
If insurance coverage for marriage therapy is limited or unavailable, several payment alternatives can make these services more accessible. Many therapists offer sliding scale fees, adjusting session costs based on income. Therapists set their own criteria for these reduced rates.
Community mental health clinics often provide services at lower costs, utilizing sliding scale fees. University training programs also offer affordable therapy, provided by students under licensed supervision. Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) allow individuals to use pre-tax dollars for eligible medical expenses, including therapy. While general marriage counseling may not always qualify, therapy used to diagnose or treat a mental health condition is typically an eligible expense. Paying out-of-pocket is always an option, and some therapists may offer payment plans or adjusted session frequency to manage costs.