Omaha Relationship Counseling Blog

Have You Heard That Insurance Does Not Cover Couples Counseling?

It most cases, it doesn’t, but let me explain some different things to you about therapy and insurance.

People often think they can use their insurance for couples counseling or marital counseling. And prospective patients will call and ask if I “take” their insurance. Let’s look at these two issues.

The vast majority of insurance does not cover couples counseling or marital counseling. There are a small few that cover (I have heard the insurance for Google covers couples therapy but I don’t know that for sure) and I once heard the Blue Cross paid under one of its many plans. And sometimes therapists will bill for one of the couple if he or she has a diagnosis, but that can be tricky. If the session does not deal with the issue the patient with the diagnosis brings, then it should not be billed as part of the treatment for the patient. It is usually best to assume it is not covered, BUT to find out for certain call your insurance company and ask them if couples or marital counseling is covered under your specific policy.

Many therapists, myself included, can bill most every insurance company for you, and in that way they/I “take” your insurance plan. You may be asking if the therapist will send in your claims. Some therapists don’t, but most do. I am set up to easily send in (also called “submit”) your claims.

But you are probably actually asking (when you say, “Do you take my insurance?”) is if the therapist is “in the network,” “in your plan,” or “in-network.” A therapist is in or out of your network and you can usually look that up online or you can ask him/her. Rarely, but it does happen, a provider can get on your plan to work with you, temporarily work with you for an agreed upon rate. Sometimes that works out well enough that the therapist will do it, and there are times when it will not be enough of a benefit for the therapist to make that choice. When a therapist is in your network, you will, most likely, have to pay less to reach your deductible (the part you have to pay in full before insurance starts paying), your co-insurance will pay more (meaning that when your insurance does start paying they will pay more of the total allowed fee than if you use an out-of-network provider), and your out-of-pocket-maximum will be less than when seeing an out-of-network provider (meaning you will pay less overall, “out of your pocket,” to see the in-network provider than the out-of-network provider). So you will, most likely, pay more out of your pocket and your insurance will pay less for you if you see someone out-of-network. But realize that many plans still pay well for you to see an out-of-network provider. I have seen multiple patients where the out-of-network rates paid just under 70% of the fee when the deductible was met, and I have seen patients where their out-of-network portion was much higher than their in-network costs. The best way to know, again, is to call your insurance company and ask.

So if it costs more, why would anyone choose to see a marital or couples counselor who is out of network? It will usually cost more, but it is more private (the insurance company is not a part of it and doesn’t not know anything about it). You may also be willing to pay more to see the provider of your choice. A better qualified provider may well save you money in the long haul.

Whatever the case, I am always willing to help you get to a therapist if I am not the right one for you, if I am not under your plan and you need the savings that an in-network provider would bring you. If you need the help, it is important to go and get it!