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The Deal with Insurance and Marriage Counseling

The Deal with Insurance and Marriage Counseling

Posted on August 23rd, 2015 by Raffi Bilek, LCSW-C

At the Baltimore Therapy Center we frequently get calls that begin like this: “Hi, I’m looking for marriage counseling. Do you take Blue Cross Blue Shield?” While the short answer is yes, there’s unfortunately a lot more that needs to be said on this topic.

The reality is that almost no insurance company will pay for marriage counseling. This is because they will tell you that marital or relationship problems are not a medical issue, and therefore it’s not something they cover. Sadly, in this case they happen to be right. Marital problems are not a medical issue. (What if one of you actually has some kind of disorder that’s causing problems? We’ll get there. Hang tight.) In the same way that you can’t turn to Aetna or Cigna (but you CAN turn to the Baltimore Therapy Center!) to help you manage a dispute with your boss, you can’t ask thecounselingm to help you address a dispute with your spouse. They are there to cover medical expenses and medical expenses only (defined according to their own dictionary, because when there is no alternative to their system, they can get away with a lot). And, as they say, health insurance is a business, not a charity. There you have it.

What if I do have a mental illness?

Now, as I alluded to above, there are circumstances where you may indeed be eligible for insurance reimbursement for couples therapy. Let’s say you or your partner or both of you have some mental health diagnosis such as major depressive disorder, social phobia, or borderline personality disorder, and let’s say this diagnosis is negatively affecting your relationship (as any of these diagnoses is very likely to do). Now you have a situation in which your insurance carrier may pay for your counseling. (I say “may” because some plans don’t offer coverage for counseling at all). But they are still not paying for you to deal with your relationship problems; rather, they are paying for your individual recovery from whatever disorder you are struggling with, and they accept that bringing your spouse into the picture is going to help achieve that.

This is fortunate, because there is no doubt that relationship dynamics can have a major impact on things like depression, anxiety, and more. I could certainly envision a healthcare system that insists there is never any “medical” benefit to couples counseling and then even this avenue would be closed to insurance reimbursement, which would be a real shame.

A Caveat

In reality, you are likely to find many marriage counselors out there who will tell you they do take your insurance for marriage counseling. What they are almost certainly doing in order to get insurance to pay for it is labeling you or your partner with a diagnosis – major depression and general anxiety disorder “not otherwise specified” are two common ones – and claiming to the insurance company that they are treating you for that. While it is true that you are probably feeling sad and/or anxious in your relationship if you are seeking counseling, these diagnoses are real categories that you don’t fall into just because you’ve had a bad day, week, or even month or year.

In addition to being not-so-ethical (which could theoretically land your therapist in trouble), this practice can actually have some ramifications for you. Since this diagnosis becomes part of your medical record, it could affect you if you are trying to get a security clearance, for example. In addition, my own insurance broker informed me that insurance companies do look at this kind of thing when you apply for life insurance. This is not to say that you are likely to have problems because of a mental health diagnosis. But it is definitely possible, and something you may want to consider.

The long and the short of it is, we don’t do this kind of thing. We are happy to work with your health insurance if you have a bona fide diagnosis (whether established by us or by a previous therapist or doctor), but we will not make one up so as to satisfy the insurance companies’ requirements. Whether we agree with their position or not, we don’t feel it is ethical to bill for something that isn’t there. You can certainly find therapists who will – just not at the Baltimore Therapy Center.

Learn more about our couples counseling services here.
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