Does Insurance Cover Couples Therapy? Find Out More

Couples therapy can be a transformative experience for relationships struggling with communication issues, infidelity, or general disconnection. However, one of the most pressing questions prospective clients ask is whether their insurance will cover these sessions. The answer is nuanced: many insurance plans do cover couples therapy, but coverage varies significantly based on your specific plan, provider, and how the therapy is coded.

Understanding your insurance coverage for couples therapy requires knowledge of how mental health benefits work, what types of therapy are typically covered, and how to navigate the often-confusing landscape of insurance claims. This comprehensive guide will help you determine your coverage options and make informed decisions about seeking professional help for your relationship.

Insurance Coverage Basics for Couples Therapy

Most health insurance plans, including those offered through employers and government programs, do include mental health coverage as required by the Mental Health Parity and Addiction Equity Act (MHPAEA). This federal law mandates that insurance companies provide mental health benefits at parity with medical and surgical benefits. However, this doesn’t automatically mean all couples therapy is covered.

The key distinction lies in how insurance classifies therapy. Individual therapy for mental health conditions is typically more readily covered than couples or family therapy, which is often classified differently. Some insurers view couples therapy as a life coaching or relationship improvement service rather than treatment for a mental health condition, which affects coverage eligibility.

When you seek couples therapy, your therapist will need to diagnose at least one partner with a recognized mental health condition from the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) for insurance to consider covering the sessions. Conditions like depression, anxiety, PTSD, or trauma-related disorders frequently qualify. The therapy must be deemed medically necessary to treat these diagnosed conditions.

If you’re unsure whether therapy is right for you, consider reviewing our guide on whether you need therapy to understand your specific situation better.

Types of Insurance Plans and Their Coverage

Different insurance plan types offer varying levels of couples therapy coverage. Understanding your specific plan type helps predict what to expect:

• Preferred Provider Organization (PPO): These plans typically offer the most flexibility. They cover both in-network and out-of-network providers, though out-of-network care requires higher out-of-pocket costs. PPO plans usually cover couples therapy if medically necessary, with coverage rates around 70-80% after deductibles.
• Health Maintenance Organization (HMO): HMO plans generally require you to use in-network providers exclusively (except emergencies). Couples therapy coverage depends on whether your HMO includes mental health services and whether a couples therapist is in-network. Coverage is often comprehensive for in-network services.
• Exclusive Provider Organization (EPO): These hybrid plans combine HMO and PPO features. They typically cover in-network couples therapy well but require out-of-network authorization for coverage.
• High Deductible Health Plans (HDHP): These plans often have lower premiums but higher deductibles. Couples therapy coverage exists but may require meeting your deductible first, resulting in higher initial out-of-pocket costs.

Government-sponsored plans like Medicare and Medicaid also cover couples therapy, though with specific requirements. Medicare covers mental health services at the same rate as other medical services, while Medicaid coverage varies by state.

How Therapy Gets Coded for Insurance

Billing codes are crucial to insurance coverage. Therapists use specific codes from the Current Procedural Terminology (CPT) system to bill insurance companies. The codes used determine whether claims are approved or denied.

For couples therapy, providers typically use codes like 90834 (45-minute psychotherapy session) or 90837 (60-minute session). Some therapists may also use family therapy codes (90846-90847) for couples sessions. The diagnosis code—which comes from the DSM-5—is equally important. Insurance companies are more likely to cover sessions when the diagnosis indicates a recognized mental health disorder affecting at least one partner.

Here’s the critical point: couples therapy coded simply as “relationship counseling” without a mental health diagnosis may not be covered. However, if one partner has diagnosed depression, anxiety, or trauma, and the couples therapy is being used to treat that condition, insurance is more likely to approve coverage.

This creates an interesting situation where the focus of treatment must align with the diagnosis. If you’re seeking therapy for relationship improvement without an underlying diagnosed condition, insurance typically won’t cover it. But if relationship issues are exacerbating or stemming from a diagnosed mental health condition, coverage becomes possible.

Out-of-Network vs In-Network Providers

The distinction between in-network and out-of-network therapists significantly impacts your costs and coverage:

In-Network Providers: Therapists contracted with your insurance company offer the best coverage rates. Your insurance pays a higher percentage of the cost, and you typically only pay your copay (often $20-50 per session) or coinsurance (a percentage like 20%). In-network providers have pre-negotiated rates with insurance, making sessions more affordable.

Out-of-Network Providers: These therapists don’t have contracts with your insurance. You may have to pay the full session cost upfront and submit claims for reimbursement. Your insurance may reimburse 50-70% of the “usual and customary” rate in your area, leaving you responsible for the difference. Out-of-network therapy costs significantly more but offers greater provider choice.

When searching for a couples therapist, always verify whether they’re in-network with your insurance. Many therapists maintain information about their insurance affiliations on their websites or can confirm during initial consultations. The MindLift Daily blog includes resources for finding qualified therapists in your area.

Common Coverage Limitations and Exclusions

Even when couples therapy is technically covered, specific limitations often apply:

• Session Limits: Many insurance plans cap the number of covered therapy sessions annually, ranging from 20 to 52 sessions per year. Once you reach this limit, you pay out-of-pocket for additional sessions.
• Prior Authorization Requirements: Some insurers require your therapist to obtain approval before starting treatment. Without prior authorization, claims may be denied.
• Mental Health Diagnosis Requirement: As mentioned, insurance typically requires at least one partner to have a diagnosed mental health condition. Purely relationship-focused therapy without a clinical diagnosis usually isn’t covered.
• Specific Therapist Requirements: Some plans only cover therapy from licensed clinical social workers (LCSWs), marriage and family therapists (MFTs), or psychologists. Other therapist credentials may not be covered.
• Deductible Requirements: You may need to meet your annual deductible before insurance begins covering therapy costs.
• Exclusions for Certain Issues: Some plans exclude coverage for specific issues like relationship coaching, premarital counseling, or divorce mediation, even when a mental health diagnosis is present.

How to Verify Your Coverage

Before scheduling couples therapy, take these steps to understand your specific coverage:

1. Review Your Insurance Documents: Your insurance card, plan summary, or online portal should outline mental health coverage. Look for information about therapy copays, coinsurance, deductibles, and annual session limits.
2. Call Your Insurance Company: Contact the number on your insurance card and ask specifically about couples therapy coverage. Request information about in-network therapists, session limits, prior authorization requirements, and your out-of-pocket costs.
3. Ask About Prior Authorization: Determine whether your plan requires prior authorization before starting therapy. If required, your therapist can submit this request.
4. Get Answers in Writing: Request written confirmation of your coverage details. This protects you if there are later disputes about covered services.
5. Consult with Your Therapist: Once you’ve selected a couples therapist, they can verify your benefits and often handle insurance paperwork. Many therapists have staff dedicated to insurance verification.

The process of verifying coverage takes time but prevents surprises when bills arrive. Don’t assume your plan covers couples therapy—confirm it directly with your insurer.

Alternative Funding Options

If insurance doesn’t cover couples therapy or if you’re uninsured, several alternatives can make therapy more affordable:

Sliding Scale Therapy: Many therapists offer sliding scale fees based on income. You pay what you can afford, making therapy accessible regardless of insurance status. Ask potential therapists about sliding scale options during initial consultations.

Community Mental Health Centers: Federally qualified health centers (FQHCs) provide therapy on a sliding fee scale. These nonprofits serve uninsured and underinsured individuals, often offering couples therapy at reduced costs.

Employee Assistance Programs (EAP): Many employers offer EAPs that include free or subsidized therapy sessions. Check with your HR department about whether your employer provides this benefit—it’s often underutilized.

Online Therapy Platforms: Services like BetterHelp and Talkspace offer more affordable couples therapy options than traditional in-person sessions, sometimes at rates as low as $60-90 per week.

Support Groups and Workshops: Free or low-cost relationship support groups and workshops, often offered through community centers or religious organizations, can complement or substitute for formal therapy.

University Clinics: Psychology graduate programs often operate training clinics where graduate students provide therapy under supervision at significantly reduced rates.

For those interested in specific therapy modalities, our article on cognitive behavioral therapy demonstrates how specific therapeutic approaches address particular conditions, though couples therapy typically uses broader relationship-focused methods.

FAQ

Does insurance cover couples therapy if we’re not married?

Yes, most insurance plans cover therapy for unmarried couples. Insurance terminology typically uses “couples therapy” or “family therapy” regardless of marital status. The coverage depends on whether a mental health diagnosis is present, not on your relationship status.

Will insurance cover couples therapy for divorce mediation?

Generally, no. Divorce mediation and legal counseling aren’t typically covered by health insurance, as they’re considered legal services rather than mental health treatment. However, therapy to address emotional issues related to divorce may be covered under individual or couples therapy benefits.

How much does couples therapy cost without insurance?

Out-of-pocket couples therapy typically costs $100-300 per session, depending on the therapist’s experience, location, and credentials. Licensed marriage and family therapists (MFTs) might charge $100-200, while psychologists may charge $150-300 per session.

Can I use my HSA or FSA for couples therapy?

Yes, Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs) can be used for couples therapy expenses. However, the therapy must be recommended by a healthcare provider to treat a diagnosed medical condition. Check your specific account rules, as they vary by plan.

Does insurance cover online couples therapy?

Many insurance plans now cover teletherapy, including online couples therapy, especially following the expansion of virtual care during the pandemic. Coverage depends on your specific plan. Verify with your insurer whether they cover virtual couples therapy sessions and whether the therapist is in-network for telehealth services.

What if insurance denies my couples therapy claim?

You have the right to appeal denied claims. Request a detailed explanation of why the claim was denied, then work with your therapist to address the issue. Common reasons for denial include lack of prior authorization, missing mental health diagnosis, or exceeding session limits. You can file a formal appeal with your insurance company, often with support from your therapist.

Does couples therapy require both partners to have insurance?

No, only one partner needs insurance coverage. If you’re the one with insurance and a diagnosed mental health condition, your plan may cover couples therapy even if your partner is uninsured. However, some insurers require that at least one partner is the policyholder or covered dependent.