Is marriage counseling covered by insurance?
Marriage counseling, also known as couples therapy, can be a valuable resource for resolving conflicts and improving relationships. One common concern is whether this type of therapy is covered by insurance. The answer depends on various factors including your insurance provider, plan specifics, and the therapist’s billing practices.
Coverage by Insurance Providers
General Coverage
Many insurance providers offer some level of coverage for mental health services, including marriage counseling. However, the extent of coverage can vary widely:
Mental Health Parity Laws: Under the Mental Health Parity and Addiction Equity Act, many insurance plans are required to provide the same level of benefits for mental health and substance use disorder services as they do for medical and surgical care. This means that if your plan covers psychotherapy, it might also cover marriage counseling.
Employee Assistance Programs (EAPs): Some employers offer EAPs that provide free access to a limited number of counseling sessions, which can include marriage counseling.
Specific Insurance Plan Provisions
Insurance coverage for marriage counseling depends largely on your specific insurance plan:
In-Network Providers: If your therapist is an in-network provider with your insurance company, your sessions are more likely to be covered.
Out-of-Network Providers: If you choose an out-of-network therapist, your coverage may be limited or you may have to pay higher out-of-pocket costs.
Deductibles and Copays: Even if covered, you might need to meet a deductible before insurance kicks in, and you may still be responsible for copayments for each session.
Factors Affecting Coverage
Medical Necessity
Insurance companies often require a diagnosis of a mental health condition to justify the medical necessity of therapy. Marriage counseling may be covered if:
Mental Health Diagnosis: One or both partners have a diagnosed mental health condition that impacts the relationship.
Therapeutic Goals: The therapy is deemed necessary to address specific mental health issues, such as depression or anxiety, which are exacerbated by relationship problems.
Documentation and Referrals
Therapist’s Documentation: The therapist may need to provide documentation of the therapy’s goals and progress to the insurance company.
Referrals: Some insurance plans require a referral from a primary care physician or a mental health professional to cover therapy sessions.
Verification and Pre-Authorization
Checking Your Plan
It is important to verify the specifics of your insurance coverage before starting therapy:
Contacting Your Insurance Provider: Call your insurance company to ask about coverage for marriage counseling, in-network providers, out-of-pocket costs, and any necessary pre-authorization.
Reading Your Policy: Review your insurance policy’s section on mental health benefits to understand what is covered.
Pre-Authorization
Required by Some Plans: Some insurance plans require pre-authorization for therapy services. This means you need to get approval from the insurance company before beginning counseling to ensure it will be covered.
Conclusion: Coverage Varies, Verify Your Plan
While many insurance plans do offer some coverage for marriage counseling, it varies widely based on the provider, plan specifics, and whether the therapy is deemed medically necessary. It’s crucial to check with your insurance provider to understand your coverage details.
At Moriel Mental Health (MMH), we strive to make marriage counseling accessible and affordable. Our sessions are typically free to most insurance providers, and if you are paying out of pocket, the copay is usually around $20 per session. If you’d like to explore marriage counseling options and find a service that fits your needs, please contact us at Moriel Mental Health to book an appointment. We work all throughout California and are here to support you and your partner on your journey towards a healthier and happier relationship. At MMH, we are committed to providing the care and guidance you need.
