**Billing Insurance For Couples Counseling: Navigating The Process Together**

How to Bill Insurance for Couples Counseling

Couples counseling is not typically covered by insurance, as relationship issues are not considered a mental health diagnosis. However, there are creative ways to use insurance benefits to cover the cost. This can include using one partner's individual insurance to cover sessions, alternating between insurance plans, or asking the therapist to bill as family sessions. It's important to note that billing insurance for couples counseling requires adhering to ethical guidelines and avoiding insurance fraud. Therapists must also be mindful of state laws, license requirements, and individual insurance plan specifics.

Using one partner's individual insurance to cover sessions

Using one partner's individual insurance to cover couples counselling sessions is possible if they have a mental health diagnosis. In this case, the other partner can attend therapy as a "collateral" to learn coping strategies. However, it's important to note that the focus of such therapy would still primarily be on treating the partner with the diagnosis.

While this approach can significantly reduce out-of-pocket costs, there are several disadvantages to consider. Firstly, one partner will need to meet the criteria for a mental health diagnosis to qualify for coverage. Secondly, insurance companies may dictate the type and length of therapy, which may not align with the couple's preferred approach or desired duration. Thirdly, using insurance reduces privacy, as the insurance company can request proof of diagnosis through case notes. Finally, the pool of therapists to choose from may be smaller when using insurance.

Additionally, there is potential liability if the couple divorces or ends up in court. The paperwork and diagnosis of the partner whose insurance was used may be shared and potentially used as leverage in legal proceedings, such as child custody disputes. Therefore, it is essential to carefully consider the advantages and disadvantages of using one partner's individual insurance to cover couples counselling sessions.

Alternating covering sessions with individual insurance plans

Pros

• Your length of treatment is likely to be longer as you can continue with treatment after your personal therapy allowance runs out.
• Your out-of-pocket costs are lower since you are only responsible for your copayments.
• You are both liable for future scenarios in court if you end up separating.

Cons

• You both will need a mental health diagnosis to qualify for insurance coverage.
• The type of therapy is often dictated by the insurance company. This means that if your preference for the type of couples counselling isn’t approved by your insurance company, you might have to pay out of pocket.
• Your health insurance may only cover shorter and fewer therapy sessions.
• You have fewer options for therapists available. In addition to having an already limited pool of in-network therapists, some therapists may not be willing or able to work with both of you.

Billing as family sessions under one partner's insurance

Billing couples therapy as family sessions under one partner's insurance is a legitimate way to get insurance coverage for relationship counselling. However, there are several pros and cons to this approach that you should be aware of.

Pros of Using "Family Sessions" Code for Couples Counselling:

Your out-of-pocket costs are lower as you are only responsible for the copay.

Cons of Using "Family Sessions" Code for Couples Counselling:

• One partner will need to meet the criteria and be diagnosed with a mental health condition for you to qualify for coverage.
• There is potential liability if you end up in a courtroom due to divorce or separation. The paperwork for the partner whose diagnosis was used for insurance coverage may be shared with the court and could potentially be used as leverage in child custody cases.
• Your insurance coverage may only include shorter and fewer therapy sessions. Insurance companies often dictate the length and number of sessions they will cover and it can be challenging to get approval for additional sessions.
• The type of therapy may be dictated by the insurance company. Insurance companies usually only cover brief, evidence-based models, but there may be another model or approach that the therapist finds more beneficial for your particular treatment plan.
• Counselling is less private when using health insurance, as insurance companies can request proof of the diagnosis through case notes.
• The pool of therapists you can choose from is smaller. You will have a smaller pool of providers to choose from, especially as many in-network therapists are fully booked.

To bill couples therapy as family sessions, you will need to assess all members of the couple for diagnoses and choose one partner as the identified patient (IP). The IP is typically the partner with a more severe diagnosis or the primary holder of the insurance. When creating your invoice and claim, be sure to include the name and diagnosis code of the IP. The CPT code 90847 on the claim reflects that a couples or family session therapy session took place. It is important to note that the names of other session attendees should not be listed on the claim.

Using out-of-network benefits

Greater Confidentiality

Confidentiality is a key benefit of seeing an out-of-network therapist. When you use your insurance coverage, some of the information you share becomes part of your healthcare record. For example, the therapist will report if either member of the couple meets the criteria for a diagnosis of a mental illness. This is because insurance companies only cover what is deemed "medically necessary". Additionally, having a diagnosis on your record can interfere with employment options, acquiring health or life insurance, or serving in the military. Out-of-network therapists can offer greater privacy and confidentiality.

Customised Treatment

Out-of-network therapists have more freedom to base their clinical decisions on what you need, rather than what the insurance company stipulates. For example, they can offer longer and more frequent sessions, which can be particularly useful for couples therapy. They can also continue to meet with you even after you no longer meet the criteria for a diagnosis. This allows you and your therapist to design a treatment plan that puts you first.

More Therapist Options

Insurance companies limit the number of therapists in their network, and these therapists often have long waiting lists. By considering out-of-network therapists, you can widen your pool of options and potentially get into therapy faster, which is important if your relationship is in a critical stage. Additionally, you may be able to find a therapist with a unique skill set that better suits your needs.

Reimbursement

Depending on your insurance plan, you may be able to receive reimbursement for a portion of the cost of out-of-network therapy sessions. For example, if you have a PPO or POS health insurance plan, you will typically receive partial reimbursement for out-of-network services. You will need to pay the full session fee upfront and then submit a claim to your insurance company for reimbursement.

Personalised and Highly-Specialised Services

Out-of-network therapists are not constrained by the limitations of insurance companies and can offer more personalised and creative treatment plans. They may also be able to offer out-of-the-box solutions, such as accompanying a client with agoraphobia to the grocery store. This extra attention and flexibility can benefit your progress, especially if you are seeking long-term mental health services.

Paying out of pocket

Couples counselling is not typically covered by insurance. This is because "relationship issues" are not considered a mental health diagnosis, which is a requirement for health insurance to pay for therapy. However, if you are unable to find a therapist who's in-network with your insurance plans, don't have out-of-network benefits, or prefer to keep the content of your sessions entirely private, you may opt to pay out of pocket. Here are some pros and cons of paying out of pocket:

Pros

• No diagnosis is required. Since you're not going through your health insurance, the therapist does not need to assign a diagnosis to help cover the cost.
• Counselling is more private. There is no chance of an insurance company asking for case notes, and your information remains confidential.
• You have a larger pool of therapists to choose from. The number of therapists who are in-network with your insurance may be limited.
• Your therapist can use different approaches and modalities in treatment. They are not limited to those approved by the insurance company.

Cons

• Treatment is more expensive. You have to cover the sessions completely. (If cost is a concern, you can ask the therapist if they are able to offer a sliding scale or reduced rate based on your income.)
• You may have to make a few extra calls to your insurance company. You may also end up paying more than you initially expected.

Other Options

If you are concerned about the cost of paying out of pocket, there are some alternative options to consider:

• Employee Assistance Programs (EAPs): Check if your employer offers an EAP. These programs often cover a wider range of services, including couples counselling. Sessions are usually free but limited in number.
• University or Community Clinics: Some university training clinics or community mental health centres offer low-cost or free couples counselling provided by supervised graduate student therapists.
• Sliding-scale fees: Some therapists offer sliding-scale fees based on income or discounts for buying multiple sessions.

Frequently asked questions