Key Takeaways
- Whether insurance covers couples therapy depends on your specific plan.
- Many plans cover therapy only when it treats a diagnosed mental health condition, so relationship counseling on its own is often not covered.
- Couples sessions may be covered when they are part of treatment for one partner’s diagnosed condition.
- Call your insurer with a short list of questions before your first session.
- Self-pay is an option if your plan does not cover couples counseling.
Cost is one of the most common reasons couples put off counseling. The good news is that some couples can use their health insurance. The less simple news is that coverage for couples therapy varies widely, and the answer depends on your plan and the reason you are seeking help.
This guide explains how coverage usually works, what to ask your insurance company and what options you have if your plan will not pay. If you are considering couples counseling, our team can also help you check your benefits.
How Insurance Usually Handles Couples Therapy
Health insurance generally pays for care that is medically necessary. For mental health services, that usually means therapy that treats a diagnosed condition, such as depression, anxiety or post-traumatic stress.
Relationship problems on their own are usually not considered a medical condition. Because of that, many plans do not cover couples counseling when the only goal is to improve the relationship.
Coverage may be possible when couples sessions are part of treating one partner’s diagnosed condition. For example, if one partner is being treated for depression and the relationship is part of the treatment plan, joint sessions may be billed as family or couples psychotherapy. Whether that applies to you depends on your plan, your diagnosis and your counselor’s clinical judgment.
Tip: Coverage rules can differ even between plans from the same insurance company. Always check your own plan rather than relying on general information.
Questions to Ask Your Insurance Company
Call the member services number on your insurance card and ask:
- Do I have outpatient mental health or behavioral health benefits?
- Do you cover family or couples psychotherapy, and under what conditions?
- Is a diagnosis required for coverage?
- What is my copay, coinsurance or deductible for outpatient therapy?
- Do I need a referral or prior authorization?
- Is there a limit on the number of sessions per year?
- Is this practice in network?
Write down the date, the name of the person you spoke with and a reference number for the call.
Things to Consider Before Using Insurance
Using insurance can lower your cost, but there are a few things to keep in mind:
- A diagnosis becomes part of your record. Insurance claims require a diagnosis for the person being treated.
- Your insurer may review treatment. Some plans limit sessions or ask for updates.
- The focus may need to fit the treatment plan. Covered sessions need to relate to the diagnosed condition.
None of these are reasons to avoid insurance. They are simply worth understanding so you can make an informed choice.
If Your Plan Does Not Cover Couples Counseling
- Self-pay. Paying directly keeps the decision about treatment between you and your counselor.
- HSA or FSA funds. Some health savings or flexible spending accounts can be used for therapy. Check your account rules.
- Individual sessions. If one partner has a diagnosed condition, individual counseling may be covered and can still help the relationship.
- Employee assistance programs. Some employers offer a small number of free counseling sessions. Ask your HR department.
Insurance at Artisan Counseling
Artisan Counseling is in network with Aetna, Anthem, Sentara, UnitedHealthcare and several Virginia Medicaid plans. Coverage for couples counseling still depends on your specific plan. Self-pay is also available. See our insurance and payment information for details.
Does Medicaid cover couples therapy?
Medicaid plans generally cover mental health treatment for diagnosed conditions. Coverage for couples sessions varies by plan, so check with your Medicaid plan or call our office.
Can we use insurance if only one of us has coverage?
Sometimes. If couples sessions are part of treating the covered partner’s condition, they may be billed under that partner’s plan. Your counselor and your insurer can tell you whether that applies.
Is premarital counseling covered by insurance?
Premarital counseling is usually not covered because it does not treat a diagnosed condition. Check your plan to be sure.
Get Help Checking Your Benefits
If you are not sure what your plan covers, call us at 757.503.2819 or request an appointment. Our team can help you check your benefits before your first session. Couples counseling is available at our Newport News and Suffolk offices and by telehealth anywhere in Virginia.
