Will My Insurance Pay for Marriage Counseling?

Probably not!  And if they do, your therapist might not be allowed to provide treatment that is evidence-based or research-based in a one hour-twenty minute session. Let me explain why (with the help of Dr. Kathy McMahon). You can read Dr. McMahon’s full explanation on her website. Just click here.

Health Insurance reimburses a therapist only for the diagnosis and treatment of mental illness. Insurance companies do not cover the cost of couples therapy because this is seen as maintenance. Not mental illness. In addition, they are increasingly clamping down on therapists who claim to practice couples therapy, while billing your insurance company as if they are treating one of you as an individual, not part of a couple.

It’s possible that with new tax laws you may be allowed to use Pre-Tax Flexible Spending Medical Accounts (FSA’s) to pay the costs of couples therapy. Ask your Accountant or Compensation and Benefits Administrator if you qualify for this program and what is covered.

Why should you care how your therapist bills the sessions?

The reason is simple: If your insurance provider finds this kind of insurance misuse, it might be months before they retroactively refuse to pay for sessions they inadvertently ALREADY paid for.  That means they might pay the claim today, but demand payment from the therapist tomorrow.

Whether Your Insurance Pays or Not, You are Still Liable

For this reason, most therapists have clients sign a document indicating that if an insurance claim is denied, the client is still responsible for payment. You should check carefully ahead of time, to avoid this from happening to you.

But my insurance company said that they pay for couples/family therapy?

Having a parent there for a child’s treatment, or a family member there to help another person with their mental disorder would be billed under the Procedural Code 90847: “Family psychotherapy, conjoint psychotherapy with the patient present.”

Such as, treating a family member for a diagnosis of depression.  This is not couples therapy sessions.  The focus of treatment is NOT on their marriage.

Many clients were never told this fact, and were surprised to learn that they were given any mental illness diagnosis at all, when they just went for marriage counseling.

My-Therapist is a group of clinicians and professionals that strive to maintain integrity, and to practice within the confines of our expertise. Therefore, we do not bill insurance companies for couples therapy. And you would not want us to risk our professional licenses just to save you money.

Be a Savvy Consumer of Behavioral Health Benefits

Read your policy online and be familiar with what your policy covers.

Don’t take my word for it.  Call your insurance company, and when you do, be smart and know what to ask.

Don’t say:

“Do you pay for marriage counseling?” Because they may say “Yes,” meaning  “You both can be there in the same room.”

You now know that that’s called a Procedural Code, (the procedural code for couples or family work is 90847, and it pays for 45-minutes of treatment).

Do Say:

“Do you pay for the Diagnostic Codes V-61.1?”  (ICD Codes  and DSM-5 Code:   V61.1 Counseling for marital and partner problems)

Make them look it up.  Don’t settle for some general answer like “We pay for all the codes.” 

Ask specifically for code V61.1.

If they say “Yes!” you are in like Flynn.  You have a rare plan that covers Marriage Counseling.  Be sure to ask how many sessions they will cover.  For some, I have found it is as short as 3-4 sessions.  For others, they will pay for up to 10 sessions before they expect another diagnosis to be given.  This is unfortunate.

If you check ahead, at least then you know whether your couple therapy sessions will be legitimately paid for, and you won’t be stuck with an unexpected bill in the future.