What Isn’t Covered

Health Insurance companies limit coverage to only services that are a “medical necessity”.  (That’s why it’s called Medical Health Insurance.)   In order for the insurance companies to see your counseling or psychotherapy as a “medical necessity”, the insurance companies want to be sure you have a medical mental health disorder.  This diagnosis then becomes a permanent part of your (or your child’s) medical records.  In your initial sessions, your therapist will discuss your symptoms and determine if a mental health diagnosis is appropriate or not.  (If you want to learn more about mental health symptoms and diagnostic issues, consult the DSM-5 .)

There are a number of family and personal areas where it is prudent to get professional counseling.  For example: self-improvement, career guidance, spiritual growth and direction, parenting issues or personal directions for a variety of issues; to name just a few.  We provide counseling for many individuals with these issues.   However, these are not considered a “medical necessity” by your insurance company.  “Marriage and relational problems are not considered a “medical necessity” or a medical condition by almost all insurance companies.

Consequently, almost all insurance companies do not pay for marriage, pre-marriage or relationship counseling.  We are finding a number of insurance companies are telling their policy holders their insurance covers “marriage counseling”.  We don’t understand why the insurance companies are saying this.  It gets people’s hopes up and then they are disappointed.  Out of respect for the client (and there are a lot of different insurances with different coverages) we submit the claim to the insurance company and the claim is rejected.  Then client ends up being self-pay after all.  Understandably, they are disappointed and pretty upset.

What Is Covered

When one (or both) member(s) of a relationship have a mental health disorder (depression, anxiety, PTSD, etc.), often Family Therapy is recommended in addition to Individual Therapy.  In this circumstance, usually medical insurance will help cover the cost of Family Therapy.  (Consult with your insurance company to verify if “Family Therapy” is covered when you, as a couple, are not married.  Some insurance companies define “family” as part of a married couple.)

When you come to counseling due to a mental health illness or a “medical necessity”, the therapist’s treatment focus should be on the person with the disorder.  And for those that want to use insurance, the claim can be legitimately filed to your insurance company.  The treatment focus is on the person with the disorder.  This might indirectly help the relationship but this treatment is not marriage  counseling. Many folks have terrible marriages and want the therapist to provide “marriage counseling” and for obvious reasons, want insurance company to pay for those services.   This creates a moral dilemma for the therapist.  And it is important to keep in mind insurance companies audit clinical records in an effort to ensure services are appropriate and correct charges have been submitted;  fees are retracted if it’s inappropriate.

Let us encourage you if you are in a relationship that is spiraling downward; Get Help!   If you are seeing the conflicts in your relationship growing; resulting in tension and distance; Get Help!  Think about “How much is my marriage & family worth?”  Find and work with an effective marriage and family therapist. It is one of the best investments you could make; it is well worth a temporary change in your financial priorities.

We understand some families are reluctant to seek professional help because of finances; call and inquire about various options.  Surprisingly,  most people benefit greatly from just a few therapy sessions; appointments can be spread out to every few weeks in order to help with the cost. Some of the counselors are able to adjust the fees for families with struggling with financial hardship.  Also, there are a number of churches and other subsidized agencies in our community that offer professional counseling and are able to help with fee adjustments.

A simple, concise way to evaluate are you needing “Family Therapy” or “Marriage or Relationship Counseling” is to answer this question:  What is the problem or issue in your life you want help with in counseling?  Do you want the focus to be on the Marriage or Relationship issues?   Or do you want the focus of the counseling to be on how the spouse/partner can be supportive of the patient that has a specific mental health issue?

As we said earlier, keep in mind:  It’s not “how much does counseling cost”; it’s “how much is counseling worth”?  Once you’ve made that decision, then change your priorities in order to get the help you need.  We have all known what it’s like to want something so much we are willing to make sacrifices to get it.  If it’s important, “Where there’s will there’s a way”.  (A car, a special gift, a house, a cruise or trip; “where there’s a will …”)

One thing we know for sure, counseling fees are a lot less expensive than attorney fees.