How Does Couples Therapy Work with Insurance? A Guide to Ethical, Effective Care

I strongly believe in using insurance benefits whenever possible—you’ve earned them! But when it comes to couples therapy and insurance coverage, the setup is complicated. Many experienced couples therapists don’t bill insurance directly. Here’s why, and what options are available.

To process a claim, most insurance plans require a mental health diagnosis for medical necessity. In couples therapy, however, the “client” is the relationship, not just one partner. Billing insurance would mean labeling one partner with a mental health condition, often undermining the therapeutic work by pathologizing them. This goes against the purpose of relationship therapy, which focuses on helping partners create healthier dynamics, not diagnosing one person as “the problem.”

Because of these issues, most seasoned relationship specialists choose to work on a self-pay basis to provide ethical, quality care. While some new or generalist therapists do take insurance, they often lack the specialization that experienced couples therapists bring to the table.

Fortunately, if you have out-of-network benefits through a PPO (not HMO) plan, you can still offset costs. Many clients can submit out-of-network claims for partial reimbursement, covering up to 80% of the session fee—making this investment similar to a copay. This way, you can work with a seasoned couples therapist and still use your insurance benefits.

Working with an out-of-network couples therapist may be one of the best decisions for your relationship. For any questions about couples therapy, insurance options, or referrals to more cost-effective providers, feel free to reach out!