Is Marriage Counseling Covered by Insurance?

Is Marriage Counseling Covered by Insurance?

A common question is whether marriage counseling is covered by insurance. The answer is generally no, but there are some exceptions.

Insurance billing is based on “diagnostic codes” related to medical or mental disorders and not relationship dynamics, and relationship issues do not currently have a billable diagnostic code.

Exceptions

An exception to this situation may be counseling that is related to a partner who has a diagnosed mental illness. For example, one partner may be diagnosed with bipolar disorder, and the other partner may be able to participate as part of their partner’s support system.

As the landscape of healthcare continues to change, what is covered is changing too. While most insurance companies specifically exclude marriage counseling, some may not. If you’re not sure, call your health plan and ask.

If there are benefits for marriage counseling, be sure to ask about any limits on coverage, out-of-pocket expenses and for a list of in-network providers.

EAP

Some employers offer their employees a benefit known as an Employee Assistance Program (EAP). Among other services, an EAP may provide a set number of counseling sessions (typically 3 or 5) for the employee.

Brief counseling for marital/family issues may be allowed. However, this benefit is extremely limited, and marital therapy generally extends well beyond 3 or 5 sessions. If you happen to have this benefit, you will:

  1. Need to obtain prior authorization, and;
  2. Be sure the therapist you choose is in network and willing to provide marital counseling in this context.

Without coverage for marriage counseling, the other option is to make arrangements with your provider to pay out-of-pocket.

Written by
Dr. Dawn Ferrara, LMFT