Insurance and Couples Therapy

While I am an in-network provider with Blue Cross and Blue Shield, I will not bill insurance for couple’s therapy for the following reasons:

• Couples therapy is not a provided benefit under most insurance plans because plans require medical necessity for treatment. This means that to use health benefits for treatment, an individual requires a diagnosable mental health disorder while the therapist needs to prove that the disorder is causing significant impairment in your life on a day-to-day basis. While you may have anxiety, a depressive disorder, or other mental health challenge, the focus of treatment in couple’s therapy is the treatment of your relationship dynamic rather than on your mental health condition. The insurance company does not see communication and relationship challenges as medically necessary. In couples therapy the relationship IS the client and therefore not recognized by insurance companies. They only cover the mental health of the individual who is insured.
• It is possible that if you call your insurance company and ask if they cover couple’s therapy they may say “yes” but it does not guarantee coverage of services, even if you obtain an authorization number. What the insurance company is referencing in saying “yes” to couples counseling is that they cover a procedure code that allows a person’s family member or significant other to be present in therapy. The focus of counseling is not on your relationship, but rather the treatment of a diagnosable mental health condition. They consider your partner as a support in the treatment of your mental health condition, not as a person also receiving treatment for relationship challenges. If you wish to call your insurance company to inquire about couples therapy coverage, you need to be specific and ask about covering the diagnostic code Z63.0 “Relationship Distress with Spouse or Intimate Partner” for procedure code 90847.
• Labeling one person as the “identified patient” can unbalance the treatment and run the risk of pathologizing a partner. Seeking fairness and equal responsibility for contributing to the challenges and health of the relationship is my goal in couple’s therapy.
• I am dedicated to providing ethical treatment, and taking advantage of a medical diagnosis to justify treatment of a relationship issue is misleading and not an ethical practice.