Does Insurance Cover Couples Therapy?

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If you’re considering couples therapy, one of the first questions you likely have is whether your health insurance will cover it. The answer is usually no, but there are some exceptions and alternative options to consider.

Under federal laws like the Affordable Care Act and Mental Health Parity and Addiction Equity Act, insurers must provide equal coverage for mental health conditions as they do for physical health issues. However, this does not usually apply to couples counseling since relationship issues are not considered a medical diagnosis.

Is couples therapy covered by insurance?

Do most insurance plans cover couples therapy? No. Most insurance plans do not cover couples or marriage counseling. Health insurance typically only covers services deemed “medically necessary” to treat a diagnosed mental health condition. Relationship issues alone do not meet this criteria.

“I got my previous marriage counseling covered. How did my therapist do that?”

Using insurance for “couples therapy” typically requires designating one partner as the “identified patient” with a mental health diagnosis, even if the focus is supposed to be on the relationship. However be aware that the sessions will be half the time needed for effective couples therapy.

Some plans are starting to only cover family therapy if a child with a diagnosis is involved.

“My insurance company says they covers, so I’m good, right?”

I suggest you read this:

CPT code 90847, is a Procedure code for family therapy. It does not permit marriage counseling. Read more about procedure codes and diagnostic codes below.

Procedure Code (CPT Code):

A procedure code, also known as a CPT (Current Procedural Terminology) code, identifies the specific service or procedure performed by the healthcare provider. In mental health treatment, this code indicates factors like the length of the session and how many people were present. For example, CPT code 90847 signifies a 50-minute family or couples therapy session. While the procedure code shows that multiple people attended the session, it does not guarantee insurance coverage. The diagnostic code is the determining factor in whether the service is deemed medically necessary and eligible for reimbursement.

Diagnostic Code:

A diagnostic code, such as the ICD-10 codes, is used to identify and describe a patient’s specific mental health condition or diagnosis. This code is required for insurance billing purposes and communicates to the insurance company the reason for treatment. In the context of couples therapy, the relevant diagnostic code for relationship issues is Z63.0.

However, most insurance plans do not cover Z-codes, as they are not considered medically necessary mental health conditions. Therapists may sometimes assign a mental health diagnosis to one partner to secure coverage, but this is considered insurance fraud if the diagnosis is not genuine.

In addition, many couples will argue about “who has the problem” in a marriage. Assigning one of you as having a mental health diagnosis is often counterproductive, even if it is done for insurance purposes.

Legitimate Ways to Get Couples Counseling Covered

While standard health insurance usually won’t pay for couples therapy, there are some legitimate ways to get help:

• Employee Assistance Programs (EAPs)

Check if your employer offers an EAP. These programs often cover a wider range of services, including couples counseling. Sessions are usually free but limited in number.

• If One Partner Has a Mental Health Diagnosis

If one partner has a diagnosed mental health condition that is negatively impacting the relationship, the other partner can sometimes attend therapy as a “collateral” to learn coping strategies. The focus is still on treating the partner with the diagnosis.

• If we’re not married, can my partner still act as a collateral?

Yes, collaterals are not considered “patients.” But acting as a collateral when you aren’t is again, considered insurance fraud

For marriage counseling, it doesn’t matter whether you are married or not, insurance will not cover your marriage counseling unless these particular conditions apply.

• University or Community Clinics

Some university training clinics or community mental health centers offer low-cost or free couples counseling provided by supervised graduate student therapists. Research studies may also provide free treatment. Don’t discount them as a valuable source for high-quality couples therapy. Dr. Bill Doherty began Discernment Counseling in a University Clinic and many fortunate couples received his expert care.

• Sexual Dysfunction

If one or both partners has a diagnosable sexual dysfunction, insurance may cover couples therapy as a legitimate part of treatment. However, not all plans cover sexual disorders.

Sex therapy is a a set of specific therapy approaches that helps change their beliefs and behaviors about sex inside and outside the bedroom. You can attend alone, but it’s even more effective when you attend with your partner. Women with Hypoactive Sexual Desire Disorder and orgasmic disorder were particularly helped when it was mainly due to relationship issues or other emotional or psychological factors. CBT and even mindfulness practices have been used to teach women how to tune in to erotic sensations. Some, but not all insurance companies provide coverage. A medical referral may be necessary.

While most of us have heard of “the little blue pill” (Viagra)  pharmaceuticals alone don’t often resolve sexual disorders. Working with a qualified sex therapist is often needed. To find out if your health insurance cover sex therapy, first contact your insurance provider and then AASECT.org to find a qualified provider.

Marital or relationship problems severely impact the health and wellbeing of the individual and the family. We know from clinical research that relationship distress worsens common ailments such as depression and anxiety. And while treatment for marital distress has had a legitimate insurance diagnostic code for decades, and in its most recent form since 2016, (Z63.0), few clinicians use it.

Know the Lingo

Does Blue Cross Blue Shield cover marriage counseling?

Insurance companies are not required to cover couples counseling. While Blue Cross Blue Shield is often generous with reimbursements for psychotherapy and widely accepted by therapists in the USA, it is unlikely that a claim submitted for marriage counseling would be paid.

Does Cigna cover marriage therapy?

While you can find Marriage and Family Therapists on most insurance panels, this is no assurance that they’ve had more than a single course in marriage therapy. Ask specifically about what type of training they’ve conducted after graduate school and see if it is from a reputable training institute. Insurance companies are not required to cover marriage therapy. To determine your benefits, call Cigna using the number on the back of your ID card, or check www.mycigna.com under “View Medical Benefits Details.” 

Does United Healthcare cover marriage counseling?

If you find ads that promise to take your United Healthcare coverage for marriage counseling, be wary. Be sure to ask how they know what insurance plan you have, and exactly how they intent to bill. Remember that the diagnostic code is linked to a diagnosable mental disorder, and that’s not an issue to take lightly. Your therapist might recommend the Diagnostic code F43. 23 used for Adjustment Disorder (AD) with Mixed Anxiety and Depressed Mood. It is sometimes known as situational depression. It occurs when an individual is unable to adjust to or cope with a particular stress or a major life event. While it seems harmless, and such a diagnosis is required by law to be kept confidential, many employment contract have clauses allowing them to view relevant medical records. 

Online couples therapy that takes insurance?

It should, if your insurance covers face-to-face couples therapy. But again, there is no requirement for insurance companies to cover Z codes (Z00–Z99). These are behavioral or situational diagnosis codes used when a client doesn’t have a known mental health disorder.

If your insurance provider doesn’t cover couples therapy in person, it is unlikely they will do so online. For other diagnoses, however, there should be parity. If your online provider promises to take your insurance for online marriage counseling, check before you are seen about what psychiatric diagnosis you will be given.