First, I want to say I very much want people to use their insurance benefits. You've earned them, and they should be utilized whenever possible. What many people find when looking for a couple's therapist is that most experienced, relationship specialists do not take insurance. If you'd like a real understanding, this information will help.

I, too, will not bill insurance for couple's therapy or individual therapy that is related to working on relational issues alone. If you call your insurance provider and the representative says, "Couple's/marriage therapy is covered", that is fine; however, experienced couples' therapists still will not file a claim with insurance because we use relationship/systemic based therapies and we consider the dynamics the issue, not one person.

When you see a couple's therapist with your partner, the dyad (the two of you) is the case. I am a therapist to both of you. It is often a fear that the therapist will take sides, find fault, blame one person or one issue. Experienced therapists don't do this. The couple is my client. I am working with the couple and the couple dynamic. This is important to understand.

When you use health insurance, just like when you go to your GP/PCP, there must be a diagnosis(for example the flu) on the insurance claim. The clinician's notes reflect treating the flu. The assessment is for symptoms of flu and the treatment would be evidence-based for flu. All of this must align, and the insurance company has the right to all of these records. This is the "medical necessity" that is expected any time you use health insurance. The same expectations apply to mental healthcare. Just like the GP must code and bill what they diagnose and treat on the day of service, so must the therapist. If I see a couple for relational issues, I cannot code an individual with major depressive disorder. 

So back to the couple's therapy discussion where the couple is my client. Health insurance would require that I diagnose one person in the dyad with a mental health diagnosis to pay the claim. Now I would be diagnosing one person, but one person is not the client, the couple is, remember? This requirement undermines therapy by identifying one person in the dyad as the "identified patient" (yes, that is the term used), by pathologizing one person, and asserting the "presenting problem" (yes, that is the term used) is the reason for the therapy. This is precisely the fear of many couples when they enter therapy--the therapist is going to think/say/infer/hint that I'm the problem. We study the psychology of this extensively in graduate school. This isn't about money for therapists. This is about ethical, effective care. And working with insurance in the couple's context is problematic because it creates the very dynamic that people are concerned about from the outset. And just to be very clear, a claim without a diagnosis will be denied, period. 

But this is not all, in couple's therapy we are working on relational dynamics: communication, challenges with the division of labor, conflict resolution, trust, desire, betrayal, vulnerability, intimacy, shared interests, etc. There is no diagnosis for these concerns. Next, couple's therapy specialists are using evidence-based couple therapy modalities such as Emotionally Focused Therapy or Gottman Method, or Imago Relationship Therapy. Alternately, if I am treating a mental health diagnosis, such as major depressive disorder or generalized anxiety disorder, I use therapy modalities that are evidence-based to treat those concerns; these modalities are not the same. My notes reflect my approach, in every session. So remember flu diagnosis, flu symptoms, flu treatment; it must all align or there is an ethics issue. 

Another issue is if there is a mental health concern and someone is using their insurance on couple's therapy, he/she/they cannot use those benefits for individual therapy. Insurance will not pay two claims for the same concern. This is where people need to use their insurance benefits, to seek individual therapy. I want clients who are contending with a mental health challenge to have assess to their individual therapist to address this. This is ethical practice. 

Often inquiring clients are confused because previous clinicians have taken insurance for couple's therapy. Sometimes new therapists, therapists trying to fill their caseload, or generalists who are not specialists in couple's therapy may take insurance. My colleagues in the area, who specialize in couple's therapy, as I do, are ALL self-pay. I refer to these colleagues weekly because we all stay full.

So why do I still work with insurance? Because I am passionate about working with those contending with anxiety, depression, narcissistic abuse, etc. Moreover, it is important to me to serve the community, and to offer affordable, insurance-based services to those contending with mental health concerns.

Couple's therapy is an investment in time, money, emotion, and effort into one of your most important relationships using a systemic perspective. When your relationship is healthy, everything else works better. If my relationship were on the line, I would find an experienced relationship specialist and make that investment. If finances are of concern, there are those specializing in couple's work who charge less, offer a sliding scale--for me that is a better option than finding a generalist or an individual therapist who will take your insurance. If you'd like some cost-effective choices, I'd be glad to offer referrals.

I hope you have a better understanding of this nuanced concern and clarity about why I do not bill claims for couple s therapy. I would have to diagnose one member of the dyad when the dyad is the case/client undermining the therapeutic alliance and approach, and I would not be able to use couple's therapy modalities making the therapy ineffective. This is not good practice at minimum, and potentially unethical and insurance fraud to apply a diagnosis that is not the focus of treatment.

Wow, if you made it this far, that was a lot! I take pride in my work as a relationship therapist, and I would be honored to work with you. I sincerely hope you've found this information helpful.