Frequently, couples express their desire to utilize their insurance for marriage or couples counseling, mentioning previous experiences where other therapists accepted their insurance for such services. However, at Growth & Recovery, we do not follow this practice. Allow us to elaborate.

Insurance providers typically mandate three criteria for covering or reimbursing counseling sessions:

  • 1
    Clear identification of a client.
  • 2
    A recognized mental health necessity or diagnosis for identified client.
  • 3
    Documentation demonstrating treatment directly benefiting both the identified client and the mental health diagnosis.

Here’s How Insurance Works for Individual Therapy

In many instances, health insurance providers typically cover individual therapy due to its straightforward nature for therapists to identify clients, assign a diagnosis based on presenting issues, and offer treatments aligned with the diagnosis.

For instance, if Jane seeks therapy for Generalized Anxiety Disorder, the therapist might employ cognitive behavioral therapy as a suitable treatment. This practice aligns with ethical insurance usage, allowing therapists to furnish documentation corresponding to the provided treatment. During audits of the client’s file by the insurance company, the therapist can demonstrate how therapy was administered to Jane, utilizing established treatment modalities like cognitive behavioral therapy for her diagnosed condition of Generalized Anxiety Disorder.

What About Insurance for Marriage or Couples Counseling?

Offering insurance coverage for marriage or couples counseling presents a distinct challenge. Who exactly constitutes the client? In this context, it’s the relationship itself – the collective involvement of both individuals. Insurance companies currently lack a definitive framework to address this complexity. Their systems typically operate on the premise of a single client. While they might occasionally reimburse for “family sessions”, they still seek clarity on who the primary client is.

This brings us to the second issue. What constitutes the diagnosis? When we engage in marriage or couples counseling, the diagnostic concern we address is “relationship problems,” categorized under the code Z63.0. However, insurers typically do not cover this diagnosis. Moreover, let’s consider a scenario where you meet the diagnostic criteria for Generalized Anxiety Disorder. If you seek marriage or couples counseling at Growth & Recovery, we are not treating your Generalized Anxiety Disorder. Instead, we are focusing on addressing the challenges within your relationship, with the assumption that you may be receiving separate individual therapy for your anxiety disorder or that improvements in your relationship may positively impact your anxiety over time.

In either case, the treatment Growth & Recovery provides couples most often utilizes the Gottman Method, a highly effective method supported by evidence for assisting couples. It is not aimed at treating individual mental health diagnoses. Consequently, the documentation of your sessions will reflect that both partners are considered clients, we are addressing relationship issues, and employing the Gottman Method as the therapeutic approach. Regrettably, we have not yet encountered an insurer willing to cover this type of therapy for two clients at a time.

Why Do Other Therapists or Practices Offer Insurance for Couples Counseling?

Why Do Other Therapists or Practices Offer Insurance for Couples Counseling?

Why might your previous therapist have billed insurance? Some therapists bill insurance because they’re not strictly conducting couples counseling.  Instead, they focus on treating the specific diagnosis, with your partner occasionally participating in sessions to learn how to support you in managing that diagnosis. Others may have a different interpretation of insurance regulations, genuinely believing they’re adhering to them. Then, some prioritize the outcome over the method. They recognize the importance and efficacy of couples counseling but choose to diagnose one partner, code sessions accordingly, and hope that insurance audits won’t occur.

After consulting with insurers and reputable colleagues and trainers in our field, we’ve come to the conclusion that we cannot ethically bill insurance for the marriage or couples counseling we provide. However, other counselors and practice owners may reach different conclusions based on their considerations and we highly encourage you to have these discussions with any provider you see.

Skill & Training Matter

Lastly, an adept marriage or couples counselor will possess extensive training and certifications. The role demands a skill set surpassing that of a proficient individual counselor. While counselors in training may accept insurance as they acquire proficiency in various models, a seasoned marriage or couples counselor, by the time you engage with them, will have counseled numerous couples, undergone extensive training sessions spanning hundreds of hours, and received supervision from seasoned experts in couples counseling.

Benefits of Private Pay vs. Using Insurance for Marriage or Couples Counseling

Advantages of paying for marriage or couples counseling sessions privately:

  • No need for a diagnosis: Since you’re not utilizing health insurance, the therapist doesn’t have to assign a mental health diagnosis to facilitate cost coverage.

  • Enhanced privacy: Without involvement from health insurance, there’s no risk of the insurance company requesting case notes, ensuring confidentiality and aligning with HIPAA regulations.
  • Expanded counselor selection: With the freedom to private pay, you have access to a broader pool of counselors from which to choose.
  • Treatment flexibility: Therapists can employ diverse approaches and modalities in treatment, unrestricted by insurance-approved methods, for as frequent or infrequent as the couple may need.
  • Extensive experience: Our couples therapists have considerable experience and expertise in this specialty field.

Contact & Scheduling

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