I get asked this one question almost every day. Do you take insurance? Or the one that follows it immediately – Why don’t you take insurance?
The general short of it is this: Insurance paid therapy is generally diagnosis driven and restricts the total number of sessions available to clients. This ultimately limits the flexibility of therapy and its outcomes.
The long version is this: I am not an in-network provider for insurance companies because:
That means that the client in the room for me is neither one or the other one of you. Instead, when you come into my office asking for couples counseling, I want to work with you as a couple. Your relationship is of utmost importance. You as a couple is who my client is.
It has been my experience over the last several years that the above is true no matter how good your coverage is for physical health or individual counseling.
Now, I don’t know what insurance company you have coverage with or what your particular plan/agreement is. If YOU don’t know the answer to this question, call the number on the back of your card and ask them two things:
In order for insurance to be used in couples’ counseling, one of you has to receive a diagnosis of a mental illness in order to make “your treatment a medical necessity”. This mental illness diagnosis remains in your permanent health record. simply to work on a marriage/couples issue. Without having a diagnosis, the insurance companies do not deem treatment necessary, and therefore, will not pay for it.
What you may want to say to me right about now:
“I know we have great insurance coverage through my spouse’s work – we never have to pay anything when we go to the doctor. Ever.”
– There is a big difference in insurance coverage for physical health/doctor’s/dental visits and mental health coverage.
“But I used my insurance for counseling in the past and they covered it all.”
-Again, if you were seen for individual counseling, like dealing with someone’s passing, your ADHD, depression, OCD or the like – it’s different.
“But we talked to this other therapist who does bill in network with our insurance.”
Either that’s because your insurance company does cover couples counseling OR he/she is willing to make one of you two the identified patient in the room and give you or your spouse a diagnosis of a mental illness in order to bill insurance — which,in return, will deem treatment necessary and covered by your provider.
And, as a side note, this is important for you to know also as I don’t think many people realize this. If the insurance company audits that therapist at any point (even months after you’ve completed work with that therapist) and finds out that he/she was doing couples counseling/marriage counseling and not, in fact, treating your depression or your spouse’s anxiety (or whatever diagnosis the therapist gave you), the insurance company will ask for those reimbursements back if they don’t cover marriage counseling. Which for you in the end means that you will be liable for the full amount to your marriage counselor at that time.
Going back to my original answer — Having said all that, when clients walk in the room with a desire to work on their marriage/relationship, I prefer to see the relationship itself, or the ‘couple’, as the client, as opposed to treating one of the two individuals involved in the relationship.
And that is why I am NOT in-network with insurance companies.
A. Now, sometimes couples have been able to use their out-of-network benefits to cover their work with me. If you don’t know whether or not you have out-of-network benefits, AGAIN, please call the number on the back of your card and find out, asking them – per your particular plan/agreement and inquire whether you have out-of-network benefits for marriage counseling.
For most people, the out-of-network benefits only covers a portion/percentage of the fee and usually has a deductible that you need to meet first before that even goes into effect. Oftentimes, that deductible is pretty high.
Based on the information above, if you do have out-of-network benefits for marriage counseling and would like to use it, what we can do then is this:
You will pay the fee at the time of the appointment. You will then submit a super-bill (which I will provide you with) to your insurance company and receive a reimbursement at a later time. Generally, I provide super-bills on a once a month basis.
B. Sometimes, clients have been able to use FSA or HSA cards to pay for counseling. The same thing is true here – Please find out BEFORE-hand whether you can use those funds for this particular service.
I don’t want you to have an added stress of bad news right as we are starting to unpack some of issues that you need help with – a surprise phone call to tell you that you are not able to use the funds you thought were yours to use.
When in doubt, ask. It is your responsibility to know the answer to this – Please inquire about it beforehand.
If you have a question about insurance and marriage counseling that I have not covered here, please contact me by using the form HERE. If you find out that you have marriage counseling coverage and would like me to give you a name or two of colleagues who are couples’ specialists like me, I would be happy to provide that for you. Please don’t hesitate to contact me.