Navigating Insurance Coverage For Couples Counseling: Understanding The Dynamics For Unmarried Partners

How is Insurance Billed for Couples Counselling When Not Married?

Couples counselling is not typically covered by insurance as relationship issues are not considered a medical diagnosis. However, there are some exceptions and alternative options to consider. For example, 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. It is important to note that this type of therapy is focused on treating the partner with the diagnosis, and not on the relationship itself. Additionally, most insurance plans will only cover medically necessary services, and relationship issues typically do not meet this criterion.

Using one partner's individual insurance to cover sessions

Using one partner's individual insurance to cover couples counselling sessions is possible, but there are several factors to consider. Firstly, one partner must meet the criteria and be given a valid mental health diagnosis for the insurance to cover the sessions. This diagnosis must be a genuine condition that is negatively impacting the relationship, such as depression, anxiety, or adjustment disorder.

Using individual insurance to cover couples counselling has several advantages. Out-of-pocket costs may be lower, as you may only be responsible for the copay, with the insurance company covering the majority of session costs. It may also be easier to keep track of your coverage if it is all in one place, especially when compared to using out-of-network benefits, which can require additional paperwork.

However, there are also several disadvantages to this approach. There is potential liability if the couple decides to divorce and/or end up in court. The paperwork and diagnosis of the individual whose insurance is being used may be shared with the court and could potentially be used as leverage in child custody cases. Additionally, one partner must meet the criteria for a mental health diagnosis to qualify for coverage, and the insurance company may dictate the type and length of therapy sessions, limiting your options. Using individual insurance also reduces the privacy of counselling, as a medical diagnosis is recorded and shared with the insurance company. Finally, using individual insurance may result in a smaller pool of therapists to choose from, as you would need to select from in-network providers.

It is important to carefully consider the pros and cons of using one partner's individual insurance to cover couples counselling sessions and make an informed decision based on your specific circumstances.

Alternating covering sessions with your partner, using individual insurance plans

Alternating covering sessions with your partner, using your individual insurance plans, is a way to use health insurance to cover couples counselling. This method shares the financial balance across both parties.

Pros

Using this method, your length of treatment is likely to be longer, as you can move forward with treatment after your personal therapy allowance runs out. Your out-of-pocket costs will also be lower, as you are only responsible for your copayment. Finally, you are both liable for future scenarios in court if you end up separating.

Cons

The main disadvantage of this method is that you will both need a mental health diagnosis to qualify for insurance coverage. There are also some insurance-specific downsides to using coverage for couples counselling, including:

• 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 will 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.

Asking the therapist to bill as family sessions under one partner's insurance

This method can be a good way to lower out-of-pocket costs, as you are only responsible for the copay. However, there are some disadvantages to this approach. One person will need to meet the criteria and be diagnosed with a mental health condition in order to qualify for coverage. This can cause complications if the couple decides to separate or divorce, as the paperwork for the individual whose diagnosis was used for insurance coverage may be shared with the court and could be used as leverage in child custody cases.

Additionally, insurance companies often dictate the type of therapy, the length of sessions and the number of sessions they will cover. This means that the couple may only be covered for certain types of therapy approaches, shorter sessions and fewer sessions overall. Using insurance also means that the pool of therapists to choose from is smaller, as you are limited to in-network providers. Furthermore, counselling is less private when using health insurance, as insurance companies can require proof of diagnosis through case notes.

Using out-of-network benefits

Couples counselling is not typically covered by insurance because relationship issues are not considered a mental health diagnosis, which is a requirement for health insurance to pay for therapy. However, if either you or your partner has out-of-network benefits, you may be able to apply them towards couples counselling.

Pros of Using Out-of-Network Benefits for Couples Counselling

• You will receive partial reimbursement, which is more economical than no coverage at all.
• You'll have a larger pool of therapists available since you're not limited to just in-network providers.

Cons of Using Out-of-Network Benefits for Couples Counselling

• Partial reimbursement will typically not ultimately save you as much money as using an in-network option would.
• You will be responsible for paying the full cost of the session upfront (and your insurance company will mail you a check for reimbursement later).
• You may not be eligible for session reimbursement if your insurance plan does not have out-of-network coverage, for example, if you have an HMO Plan.
• Insurance companies can still require proof of diagnosis through case notes, which has the same potential ramifications as using individual coverage.

Steps to Using Out-of-Network Benefits

• Check your out-of-network benefits: These are typically in the Summary of Benefits that is included in a member information packet or on your insurance company website.
• Call your insurance company to verify: The best way to be sure of your benefits is to call your insurance company member services line and ask:

• Whether you have out-of-network benefits
• The amount of your deductible, and if out-of-network services apply to it
• Your out-of-pocket limit (i.e., the maximum amount you can pay for out-of-network services)
• How does payment work with an out-of-network provider?

• Ask your therapist for a superbill: When you’re looking for a therapist, ask if they’ll be willing to submit claims to your insurance company for reimbursement. Typically, they’ll provide a document called a superbill that you send directly to your insurance company at the end of each month, which will detail how many sessions you’ve had and the total fee.
• Receive reimbursement: You’ll need to pay your therapist their entire session fee at the time of service, but depending on your specific plan, your insurance company will mail you a check to reimburse a portion of the cost.

Paying for couples counselling without insurance

Couples counselling is not typically covered by insurance because "relationship issues" are not classed as a mental health diagnosis. However, there are ways to use your insurance to cover the cost of couples counselling. Here are some options if you don't have insurance or would prefer to keep your sessions private.

Pay out of pocket

If you don't have insurance or would prefer to keep your sessions private, you can pay for couples counselling yourself. The cost of couples therapy varies depending on the therapist's experience, location, and the number of sessions purchased. Therapy sessions typically range from $65 to $250 per hour, with most couples paying between $75 to $200 per hour.

Sliding scale or discounted rates

Some therapists offer sliding-scale fees based on income or discounted rates if you book multiple sessions in advance.

Online therapy

Online therapy is a more affordable alternative to traditional in-person counselling. Online platforms such as BetterHelp offer couples counselling services for $60 to $90 per week.

Public health clinics

Depending on your financial situation, you may qualify for low-cost or free mental health services through government agencies or public health clinics.

Local programs and non-profits

Local programs and non-profits may offer affordable or free family therapy.

University clinics

Some universities offer low-cost or free couples counselling provided by supervised graduate student therapists.

Employee Assistance Programs (EAPs)

Your employer may offer an EAP that covers a limited number of free counselling sessions.

Military organizations

If you are part of the military, you may be able to access free or low-cost couples counselling through military organizations.

Churches

Some churches offer free couples therapy.

National Institute of Mental Health

The National Institute of Mental Health works with many university clinics that may offer low-cost or free therapy services.

Payment plans

Some therapists may offer payment plans to help make therapy more affordable.

Free initial consultations

Many therapists offer a free initial consultation to help you decide if they are the right fit for you.

Ask your family doctor

Your family doctor may be able to refer you to affordable therapy services.

Mental health centres

Contact your local mental health centre to ask about discounted rates or sliding-scale fees.

Colleges and universities

Colleges and universities may offer low-cost or free therapy services provided by graduate students in training.

While couples counselling can be expensive, it is important to remember that therapy can save a marriage and improve your overall quality of life. There are many options available to help make therapy more affordable, so don't let cost be a barrier to getting the help you need.

Frequently asked questions