Why doesn’t my insurance cover couples therapy?
This is a question I get often due to many couples seeking support but with the use of insurance to make it happen. However, the issue is complicated and I find myself needing to create this post to answer this question. So, here we go!
Why Doesn’t My Insurance Cover Couples Therapy?
First and foremost, if you’re hoping to use insurance to cover couples therapy, it’s important to understand that insurance companies will only cover any therapy services if they are ‘medically necessary.’ In other words, your insurance company would only cover couples therapy if it deems it essential to “the diagnosis, treatment, cure, or relief of a health condition, illness, injury, disease or its symptoms” (as defined by The National Association of Insurance Commissioners).
However, insurance companies do not deem couples/marital issues as a disease, illness, or health condition. And if folks come to couples therapy wanting to work on communication issues, conflict, sex issues, infidelity, etc., addressing these issues is not considered “medically necessary.”
Insurance companies do not consider couples therapy “medically necessary.”
Why Did I Hear of Some Friends Getting Their Couples Therapy Covered by Insurance?
Sometimes people tell me they’ve heard friends of theirs or even past relationships be covered under insurance. There are some inconsistencies in the field that may be confusing. Since insurance companies do not consider couples therapy as medically necessary, how is it that some people get their insurance to pay for couples therapy?
The only way therapists can use insurance to cover what looks like “couples work” is if they assess and diagnose one of the individuals (Partner A) in the couple with a qualifying mental health diagnosis (also known as an “F code”, for example: generalized anxiety disorder, cannabis use disorder, PTSD, etc.). Then, the practitioner must create a treatment plan and justification that helps Partner A manage their symptoms, which may include the addition and presence of a partner or family member—in this example, Partner B. But Partner B would not be considered in that treatment plan at all. At least not to the insurance company, who needs to see that treatment is centered around Partner A.
But that’s the problem–that’s not couples therapy.
Insurance companies will only pay if one partner is diagnosed with a qualifying mental health diagnosis and treatment is centered around that person. But that’s not couples therapy.
That is still individual therapy work for Partner A with the invitation for Partner B’s help—all in service of addressing Partner A’s issues. The treatment focus is only medically justified for Partner A. That is not couples therapy. And to begin working on common couples issues (communication, sex, conflict, etc.) with this sort of workaround is technically insurance fraud.
This is not to accuse anyone of insurance fraud. I don’t know other people’s situation and perhaps there are many couples who are doing legit individual work with the help of their partners and billing insurance for it (as individual work). But true couples therapy that focuses on the relationship’s issues (communication, sex, conflict, etc.)–is ultimately and unfortunately not covered by insurance.
Is there any way to get couples therapy reimbursed by my insurance?
You may have heard about “superbills” or even seen my post about getting reimbursed for therapy. But a superbill only works if it includes a diagnosis code of one of the partners (who would be getting the reimbursement on their insurance). And as mentioned above, most insurance companies only diagnose “F-codes” as they’re viewed as “medically necessary.” Since most couples therapy issues fall under “Z-codes,” your couples therapist more than likely can only diagnose a Z-code (for example: Z63.0 “Problems with Spouse or Partner” or Z70.0 “Sex Counseling”).
Ultimately, your insurance company may not reimburse you via superbill with a Z-code diagnosis. In my time as a therapist of a bit less than a decade, I have not run into any insurance plan that does. But if you’d like to check for yourself (just in case!), call your insurance company and find out whether Z-codes are covered/reimburseable and let your therapist know! Use my guide on how to talk to your insurance company about superbills here.
We understand that insurance companies can be extremely frustrating to work with. While insurance companies do not view couples therapy as medically necessary, we see it as absolutely essential to the health and wellbeing of individuals, relationships/marriages, and ultimately—the family. We hope one day couples/marriage therapy is seen and treated with as much importance as other mental health services.
We do our best to give our current and prospective clients as much information and transparency as possible. If you have questions or need to discuss further, reach out to us here.
