Does Insurance Pay for Couples Counseling?

People regularly call us up wanting to know if their health insurance will cover couples therapy. The answer isn’t so black and white – it’s kind of “yes and no.” This post will break it down for you and explain what the issue is with insurance paying for couples counseling.

What does insurance cover?

Health insurance in this country is designed to pay for medical issues and medical issues only.

Therefore, you can usually use your insurance to pay for therapy, because therapy is a treatment for mental illness, which is a medical issue. (In the Obama years laws were enacted to require insurance companies to pay for the care and treatment of mental health issues the same way they do for physical health problems.)

(BTW, guess who gets to decide what is and isn’t a medical issue? The insurance company! 😖)

This works decently well for individual therapy – anxiety disorders, major depression, OCD and the like are recognized diagnoses, and therapy is a recognized medical treatment for them. When it comes to couples therapy, however, it’s a bit of a different situation: old sexist jokes aside, getting married is generally not considered to be evidence of a mental illness. (Ha!)

(Note: some people ask if insurance covers couples therapy for unmarried couples. This question is based on the incorrect assumption that the status of the couple is part of the equation, which is not the case. The question of insurance coverage for couples therapy is the same whether the couple is married, engaged, dating, or even divorced.)

Mental illness and relationships

Of the many couples I have worked with, the majority did not have a mental illness. Because here’s the thing: it is entirely normal to have difficulties in your marriage. In fact, if you have no trouble in your marriage, I’d say you are by far the exception.

Fortunately, the stigma of seeking help has continued to decline in recent years, as well it should. Seeking out guidance and support when you need help is admirable, not shameful! The result is that more and more, normal, healthy people are going to couples counseling, getting the help they need, and making their relationships really, really great.

And therein lies the rub: since couples counseling is virtually never treating a mental illness, insurance companies – regrettably, but quite understandably – almost always refuse to pay for it.

"But our last couples counselor took our insurance!"

Yes, that is entirely possible. Many therapists do accept insurance for couples counseling. What they usually do in order to get insurance to pay for their services is they make up a diagnosis of a mental illness for you, and claim they are treating you for that.

No, I am not making this up. If you have gone to couples counseling in the past and insurance paid for it, it is very likely that the therapist assigned you a diagnosis – probably a relatively mild one, like “adjustment disorder” or “anxiety disorder not otherwise specified,” and probably one reasonably related to your actual experience – but a mental health diagnosis nonetheless.

You can call your insurance company and verify this – it’s part of your permanent medical record now. (It is a source of great frustration for me personally that, apart from making up a diagnosis, many couples therapists don’t even tell their clients they are doing this.)

There are, of course, some negative ramifications of having a mental illness in your medical record:

1. It can affect things like the cost of life insurance and disability insurance.

2. It can cause trouble if you are applying for government clearance. (I have received inquiries from the government who required clients of mine to sign a release form allowing me to provide their records if they wanted to apply for jobs requiring clearance.)

3. Some employers are unfavorably disposed towards people with mental health concerns. I have had more than one client who, as a medical professional, was afraid to use their insurance for therapy because they were clear that, had their superiors discovered they were seeking mental health treatment, their careers would have been in jeopardy.

Note also that this is arguably fraud on the part of the therapist (although that probably doesn’t affect you much). Sometimes the diagnosis they give you is not farfetched based on some things you’re going through (hey, maybe you do have a lot of anxiety in your life). Sometimes it’s just the least severe thing they could reasonably justify. Often, though, it’s simply not an honest application of the definition of the mental health condition in question.

Either way, if you’re seeing them for couples counseling, then they aren’t really treating you for that disorder anyway – but they’re saying they are. No bueno.

By the way, this whole issue is also there for people who go to individual therapy just for general life help – normal stresses, relationship issues, seeking direction in life – you don’t have to be mentally ill to gain from the services of a therapist. But you do have to be mentally ill for insurance to pay for it! That’s why therapists are often diagnosing adjustment disorder, depression, and anxiety even when there’s really nothing wrong with you.

Grief is a great example – there is a whole niche of grief therapists who help people through the tragic circumstances of a loved one dying. It is certainly not a sign of mental illness to feel awful and to need some support when you lose someone you love!

"But I actually do have a mental illness!"

That may well be true! I have certainly worked with many clients who have anxiety, bipolar disorder, borderline personality disorder, ADHD, you name it.

But here’s the catch: even if you have a mental illness, that’s not why you’re going to a couples therapist. (In fact, you might already be seeing a therapist or psychiatrist for your mental health.)

For a couples therapist to say they are treating your generalized anxiety disorder – and that certainly may be a very real part of your life – when what they are actually doing is treating your marital problems – well, to me that doesn’t seem entirely aboveboard.

Yes, it is probably true that your ADHD or OCD or whatever is impacting your relationship – but again, supporting the relationship is not the same thing as treating the mental health issue.

(No judgment on any therapists for how they practice, by the way, and certainly not on any clients who use their insurance to pay for therapy of any kind. But this whole deal is one of many reasons why we don’t accept insurance for couples therapy, or at all, at the Baltimore Therapy Center.)

There’s still a chance!

All this said, it is still worth calling your insurance company to see if they’ll cover couples therapy. I have had a small number of cases where they actually do (although there actually is no billing code for couples therapy, only for family therapy – probably because family therapy is a modality that can be used to directly treat some mental illnesses).

You can go even further and ask them if they’ll pay for “Z codes.” Z codes are billing codes for things that are not actually medical in nature – things like social stressors, unemployment, and, of course, problems in a marriage/relationship.

Some insurance companies (for some plans) will actually accept these instead of mental health diagnosis codes and will pay for couples therapy, and the therapist doesn’t have to do any stretching or bending to come up with a mental health illness for you. (Z codes are what we use at the Baltimore Therapy Center when providing superbills or invoices for clients to submit to their insurance companies for reimbursement. Sometimes it actually works!)

I should note that if you saw a couples therapist in the past and your insurance paid for it, it’s possible that they did use a Z code instead of assigning you a mental illness. Again, that’s information you should be able to get from your insurance company.

So... does insurance pay for couples counseling or not?

Well, like I said earlier, it’s not so simple. The short answer is... maybe.

You can certainly find couples counselors who will take your insurance (again, whether you are married or not shouldn’t be relevant). But if everyone is being 100% legit about it, it’s not all that likely.

Need help figuring out if your insurance covers couples therapy? Feel free to reach out and we’ll see if we can help.