Is Couples Therapy Covered By Insurance?

When you start to search for marriage counseling or couples therapy here in NYC, you have a lot of questions, and one of the first questions is usually, “How much will this cost?” It is unfortunate that this is often a critical component in the decision of whether or not to seek counseling or therapy. 

The cost of therapy is also a great concern for couples because in many cases, money is an issue that causes a couple to come to therapy in the first place. So it’s important to me that my clients are comfortable with any out-of-pocket costs they may have. 

Fortunately, things are much better now than in years past. There is a much greater realization among public health experts and insurance companies that money invested in therapy or counseling is money well spent, and therefore, some mental health coverage is usually available. I provide all the paperwork you need to file your claim and obtain reimbursement. 

The nitty-gritty of insurance coverage

Mental health greatly impacts one’s work performance. For this reason, many companies have insurance policies that partially or fully cover various forms of therapy, counseling, or psychiatric help. Nonetheless, some insurers require a medical diagnosis in order to provide mental health coverage, and relationship counseling is not always covered. 

If a doctor diagnoses you with “mental distress, “adjustment disorder,” depression, or another mental health condition, most insurers will cover therapy, and a spouse may be present at sessions as support. This therapy, however, is not specifically couples therapy, although some therapists may use CPT codes 90847 (family/couples therapy with client present) and 90846 (family/couples therapy without client present) to bill insurers. CPT codes are not diagnostic codes, however, and it is the latter that drives reimbursement. The diagnostic code that would determine coverage is the one associated with the mental health diagnosis (like depression), while the diagnostic code for marriage counseling is Z-63.0. 

So the question to ask the insurer is how they cover Z-codes. You may also ask specifically about Z-63.0. If, however, one of you does have a diagnosed mental health issue, you can both benefit by being in session together to understand how to support each other through the healing process. While this is not strictly marriage counseling, such counseling can certainly help your marriage and will likely be covered. 

Other coverage options

Check with your HR department at work to see if your employer provides additional support for employees through their own program, such as an Employee Assistance Program. Medicare Part B covers 80% of couples therapy costs. And if you have an HSA or FSA, you may also be able to use your funds for couples therapy. 

Why it’s worth it

It is human nature to value more that which is more valuable. You are probably more careful with your good china than with the everyday kitchen dishes. This can also be said about counseling. I have seen in my practice that couples who benefit from therapy truly recognize that the value of their relationship outweighs the monetary cost. 

In fact, the cost of marriage or couples therapy is nominal, considering the long-term benefits. Happily married people live longer, have fewer strokes and heart attacks, and are more likely to survive cancer and major operations than single people or those in stressed, unhappy marriages. Besides the physical health benefits, it goes without saying that a happy marriage will support mental health in broader ways.

So please, do not allow the concern for financial costs to deter you from getting marital counseling. Find an experienced marriage counselor near you, or if you’re in the New York City area, contact me to discuss your particular situation to see how I can help you and your spouse grow stronger, healthier, and happier in your relationship.

This entry was posted in Couples Therapy and tagged , , , . Bookmark the permalink.