Is Counseling for Families and Couples Covered by Health Insurance?

Is Counseling for Families and Couples Covered by Health Insurance?

Our connections with others are critical to our well-being. It’s natural to feel as though you need assistance when there’s tension between you and your partner. In challenging times, couples counseling can serve as a source of support for both you and your partner as you work through challenges. However, there is a cost associated with couples counseling. Having insurance that pays for your therapy can be a huge relief, particularly if some of the problems you’re having can be tied to the amount of money you make. Here is how to determine whether or not your insurance provider will pay for couples counseling and when it will do so.

How Often Does Insurance Pay for Couples Therapy?
The vast majority of basic health insurance plans do not include coverage for couples counseling. The following is a brief overview of the various types of insurance. Find out what the expectations are for you based on these policies.

Affordable Care Act Insurance
Insurance purchased under the terms of the Affordable Care Act (ACA) will provide coverage for mental health care. According to the description, it is a “essential benefit.” On the other hand, the policies of the ACA do not permit the provision of couples therapy for the majority of relationship problems.

Why do most health plans under the Affordable Care Act not include coverage for couples therapy?

It is not a cure for any kind of ailment or problem with one’s mental health. Instead, it is a therapy that is meant to assist two individuals in improving the quality of their connection with one another.
It is not considered to be a service related to mental health in any way. People who suffer from mental problems or diseases can receive diagnosis and treatment through these services. Relationship issues are not considered to be “problems” in and of themselves.
The treatment of an illness, injury, condition, or ailment is required in order for something to be called “medically necessary,” hence in most cases, this is not recognized to fall under that category.
When treating an individual who is struggling with mental health issues, it is common for the treatment plan to include marriage and family therapy (MFT), which can also be referred to as couples therapy. These issues may include alcoholism, drug misuse, affective (mood) disorders, and schizophrenia in adults. In situations like these, an insurer may pay for therapy as long as the appropriate medical billing codes are used.4

Because the definitions of treatments might be confusing, the best course of action is to contact your insurer and inquire about the extent to which your plan covers various treatments. Nevertheless, in the vast majority of cases, it will not be covered.

Group Health Insurance Paid for by the Employer
Couples counseling is typically not covered by regular health insurance; however, it is possible that your employer’s Employee Assistance Program (EAP) will provide coverage for this service. There is a growing trend among businesses to provide their employees with access to employee assistance programs (EAPs) in the belief that doing so can increase productivity and cut down on absenteeism.

Get in touch with the manager of your benefits program and inquire about the types of coverage that are offered for couples counseling. Find out how the policy defines the coverage and what it covers.

Insurance Coverage That Is Only Temporary
Be aware that even if your immediate health insurance plan may cover “mental health,” it’s possible that the term “couples therapy” won’t be included in this coverage because it doesn’t fit the definition of “mental health.” The majority of policies for short-term health insurance feature exclusions. Many insurance companies do not include coverage for mental health care. To obtain this information, you will need to get in touch with the insurance company.

Due to the fact that COBRA is focused on providing you with the same medical protection you had when you were working, it is possible for COBRA plans to cover couples counseling provided your employer insurance plan or EAP had that coverage.5

Family counseling is covered under Medicare Part B if the primary goal of the sessions is to assist with the patient’s treatment. A mental health professional, such as a psychiatrist, family physician, clinical psychologist, and clinical social worker, must also provide the therapy in order to fulfill the requirements of the program.

In most cases, Medicare will not pay for counseling sessions with a qualified marriage and family therapist that involve the patient’s family or couple. The only exception to this rule is when an MFT is working as a member of the staff at a clinical facility or in the office of a practitioner who is eligible for Medicare.

How to Obtain Financial Support from Your Health Insurance for Couples Counseling
Expect not to be able to get reimbursed for your expenses related to couples therapy if your insurer fails to cover the cost of the service.

It is standard procedure for a therapist to request that you sign an agreement that states you will be liable for payment of coverage if your health insurance provider does not pay for it.

Even if couples counseling is covered by your insurance, there is a possibility that you will still be required to fulfill certain conditions before having your bills paid. For instance, your insurance might tell you that you can (or can’t) receive therapy from a specific sort of professional, or it might restrict you to only seeing therapists who are part of its network.

Every insurance company will have its own set of requirements. If you want to prevent out-of-pocket expenses, you should check when you start making appointments.

The types of counseling that you receive are reflected in the medical billing codes in a very specific way. Check to see if the problem you are attempting to solve has been addressed. Inquire with your therapist about the billing code that they will use going forward. After that, give your insurer a call and inquire as to whether or not it covers that code. When providing counseling for couples, a psychotherapist will not use the exact same code that is used when working with an individual client.

Make sure you don’t get any unpleasant financial surprises. Make sure you have a clear understanding of the condition(s) for which you will be receiving therapy.

Can You Make Payments With Your HSA or FSA Account?
Your health savings plan (HSA) or variable spending account (FSA) will not consider counseling for couples to be a “eligible expense” for reimbursement. If you did use funds in your HSA or FSA to pay for sessions, then there is a significant probability that you would be required to pay taxes on any monies that you withdraw from those accounts. Inquire about your available choices with the administrator of your HSA or FSA.

The vast majority of counseling sessions take place over the course of multiple sessions. When putting together your spending plan, keep this in mind. Find out how much the subsequent sessions will cost if you are given a free consultation for the first one.

Where to Go for Counseling if You Can’t Afford Individual Sessions
Counseling of any kind requires financial investment, and in the vast majority of instances, basic health insurance will not cover couples therapy. In the event that you are unable to pay for therapy, you may be eligible for financial assistance from community programs or charities in the area. Here are some tips:

Talk to your primary care physician and inquire about the possibility of receiving referrals to other couples counseling facilities.
Get in touch with the college or the mental health clinic in your area. There is a possibility that you are eligible for special pricing or programs.
You should get in touch with the church you attend to find out if it provides counseling for married couples. It’s possible that you can get assistance without having to pay for it.
Even if your health insurance does not cover therapy for couples, you should still educate yourself about the mental health services that are covered under your policy. You might be able to participate in individual therapy, which could be beneficial to you in a variety of other ways.
Remember to check your partner’s health insurance coverage as well, just in case you forget.
There are businesses that can provide internet counseling at prices that are affordable. According to the findings of the studies, the success rate is high. It is important to keep in mind that even if an online provider offers a free trial, they almost always charge for their services. It is possible that it will cost less than traditional face-to-face counseling, but any form of counseling will involve financial obligations.
If you are considering getting therapy, you should inquire about payment savings for several sessions. Many therapists are willing to work with you to devise a plan for you to pay for their services.
Questions That Are Typically Responded To (FAQs)
How much does it cost to go to counseling for a couple?
There is a large amount of variation in the cost of couples therapy due to factors such as the location of the counselor, the location of the couple seeking counseling, and the credentials of the counselor. Counseling appointments for couples typically last for 90 minutes, and the hourly rate can range anywhere from $100 to $200. Some therapists offer longer sessions. That equates to an estimated cost of $150 to $300 for each session.

Does individual treatment fall under the coverage of health insurance?
The majority of health insurance policies include coverage for individual counseling sessions to address mental health and drug misuse concerns. Plans that comply with the Affordable Care Act are required to provide coverage for behavioral health care and mental health treatments, and they must provide coverage for these services at the same level that they provide coverage for medical and surgery benefits.

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