Couples therapy may be covered by insurance in some situations, but coverage is not guaranteed. Whether your sessions are covered depends on your specific insurance plan, how the therapy is provided, and how the service is billed.
Many couples know they want professional support but are unsure whether insurance will help cover the cost. In some cases, coverage may be available when couples therapy is part of treatment for a diagnosed mental health condition. Relationship counseling focused primarily on communication or relationship improvement, however, may not be covered.
Understanding your insurance benefits before starting therapy can help you avoid unexpected costs and explore the options available to you.
Does Insurance Cover Couples Therapy?
Sometimes, but not in every situation.
Health insurance generally covers certain mental health services, including psychotherapy, subject to the plan’s terms and applicable requirements. Couples therapy can be more complicated because treatment involves a relationship rather than only an individual seeking support.
Coverage may be available when couples sessions are considered part of treatment for an individual’s mental health condition and meet the insurer’s requirements. However, therapy focused primarily on improving communication, preparing for marriage, navigating relationship difficulties, or deciding whether to stay together may not qualify for coverage.
The distinction often comes down to the purpose of treatment, the diagnosis involved, and the insurer’s medical-necessity criteria. Your insurance company can explain how these requirements apply to your plan.
Why Does Insurance Treat Couples Therapy Differently?
Insurance coverage is generally based on eligible health services and specific clinical criteria. A couple may seek therapy because of recurring arguments, emotional disconnection, trust concerns, or differences in expectations, but the insurer may evaluate whether the treatment addresses a covered mental health condition.
For example, if someone experiences significant anxiety or depression connected to relationship difficulties, sessions involving their partner may be clinically appropriate as part of that person’s treatment. To understand how anxiety can shape a relationship, read Relationship Anxiety: Why You Constantly Worry About Your Relationship.
This differs from a couple seeking professional guidance primarily to improve communication or strengthen their relationship. The insurer may treat these services differently when determining eligibility for reimbursement.
Because coverage requirements vary, it is important to confirm whether your plan covers the specific service before beginning therapy.
In-Network vs. Out-of-Network Couples Therapy
Whether your therapist is in-network or out-of-network can significantly affect what you pay for couples therapy. Understanding the difference can help you estimate your costs and determine whether you may qualify for reimbursement.
In-Network Couples Therapy
An in-network therapist has an agreement with your insurance company to provide services under negotiated rates.
Depending on your plan, you may still be responsible for a deductible, copay, or coinsurance. Coverage also depends on whether couples therapy itself qualifies under your benefits.
Being in-network does not automatically mean every type of couples session will be covered.
Out-of-Network Couples Therapy
An out-of-network (OON) therapist does not have a contracted rate with your insurance company. However, some insurance plans include out-of-network mental health benefits that may reimburse you for a portion of eligible therapy costs.
Typically, you pay the therapist directly and submit documentation to your insurance company for potential reimbursement. Your insurer determines the amount eligible for reimbursement based on your benefits, deductible, allowed amount, and other plan requirements.
Some plans offer substantial out-of-network benefits, while others provide limited reimbursement or none at all. Even when benefits are available, you may be responsible for the difference between the therapist’s fee and the amount your insurer reimburses.
If you are considering an out-of-network therapist, check your benefits before scheduling. Ask whether your plan covers couples psychotherapy, what reimbursement you can expect, and what documentation is required. To see typical session fees before reimbursement, read How Much Does Couples Therapy Cost in NYC?
Questions to Ask Your Insurance Company
Before scheduling couples therapy, call the member-services number on your insurance card. Having the right questions ready can help you understand your potential costs.
Consider asking:
- Do I have outpatient mental health benefits?
- Does my plan cover couples or family psychotherapy?
- Is couples therapy covered when treatment involves a diagnosed mental health condition?
- Does my plan include out-of-network mental health benefits?
- What is my deductible for outpatient mental health services?
- What are my copay or coinsurance responsibilities?
- Is prior authorization required?
- Are there limits on the number of covered sessions?
- Does my plan cover telehealth psychotherapy?
- What reimbursement is available for CPT code 90847, commonly used for family psychotherapy with the patient present, including certain couples therapy sessions?
CPT code 90847 is particularly useful to ask about when checking benefits. However, coverage is not determined by the code alone. The insurer may also consider the diagnosis, medical necessity, provider eligibility, and the terms of your plan.
If you are exploring out-of-network benefits, ask whether your insurer requires a superbill or other documentation to process reimbursement.
Write down the representative’s name, the date of your call, and any reference number provided. This information may be helpful if you need to follow up about your benefits later.
What Information Might Your Insurance Company Need?
To verify coverage accurately, your insurance company may ask for details about the therapist and the service.
These may include:
- Provider name and credentials
- National Provider Identifier (NPI)
- CPT or service billing code
- Diagnosis code, where applicable
- Whether the provider is in-network or out-of-network
- Whether sessions take place in person or through telehealth
You do not necessarily need to gather all these details yourself. Your therapist or practice may be able to provide the relevant information so you can ask your insurer about your benefits.
Remember that a benefits check is not always a guarantee of payment. The insurer makes its final determination according to your plan’s terms and the claim submitted.
How City Lights Psychology Helps With Out-of-Network Benefits
At City Lights Psychology, couples can explore their therapy options and determine whether out-of-network reimbursement may help make treatment more affordable.
The practice offers an out-of-network benefits checker on its website, allowing prospective patients to check their insurance benefits before beginning therapy. This can help clarify whether their plan includes eligible out-of-network mental health benefits and what reimbursement may be available.
For eligible services, City Lights Psychology also provides superbills that patients can submit to their insurance companies to request reimbursement. A superbill is a document containing information about the services provided, including relevant billing details required by the insurer.
If an insurance company encounters an issue with reimbursement, the practice can help address the issue and resubmit the claim on your behalf, as applicable. Although reimbursement cannot be guaranteed, this support can make the process easier to navigate.
Because every insurance plan is different, it is still important to understand your benefits, including your deductible, reimbursement rate, and any exclusions that may apply.
City Lights Psychology offers couples therapy for concerns such as communication difficulties, recurring conflict, emotional disconnection, trust concerns, intimacy, parenting challenges, major life transitions, and uncertainty about the future. To see how these concerns can show up in a relationship, read 10 Signs It May Be Time for Couples Therapy.
Depending on your needs, treatment may incorporate approaches such as Emotionally Focused Therapy, the Gottman Method, psychodynamic perspectives, and attachment-informed work.
The practice offers couples therapy in Flatiron, Manhattan, and virtually across New York.
You can visit City Lights Psychology to explore the practice’s out-of-network benefits checker and learn more about getting started.
Frequently Asked Questions
1. Can I use insurance for couples therapy if my partner does not have a mental health diagnosis?
Coverage depends on your plan’s requirements, including whose treatment is being billed and whether the service meets medical-necessity criteria. Contact your insurer to clarify the diagnosis and billing requirements that apply to couples sessions.
2. Does insurance cover premarital counseling?
Not necessarily. Premarital counseling is often considered relationship-focused or preventive counseling rather than treatment for a covered mental health condition. Check with your insurer to determine whether your plan includes benefits for these services.
3. Can I get reimbursed if my couples therapist is out-of-network?
Possibly. Some insurance plans include out-of-network mental health benefits, while others do not. If your plan offers reimbursement, you may need to pay the therapist directly and submit a superbill or claim. Your insurer determines the eligible reimbursement amount.
4. Does insurance cover online couples therapy?
Telehealth coverage depends on your insurance plan, provider eligibility, and the type of service. Ask your insurer whether your plan covers the specific telehealth psychotherapy service you are considering.
5. What is CPT code 90847, and why should I ask about it?
CPT code 90847 is commonly used for family psychotherapy with the patient present and may be relevant to certain couples therapy sessions. Ask your insurer whether your plan provides benefits for this code and whether any diagnosis, provider, or medical-necessity requirements apply.
6. How can I find out exactly what my insurance will reimburse?
Contact the member-services number on your insurance card and ask about couples psychotherapy, out-of-network benefits, CPT code 90847, deductibles, coinsurance, and reimbursement requirements. You can also use the benefits-checking resources available through your therapy practice. Keep in mind that a benefits estimate does not guarantee payment.
Check Your Benefits Before Starting Couples Therapy
Insurance coverage for couples therapy depends on your plan, the type of treatment, your provider’s network status, and any applicable coverage requirements. Verifying your benefits in advance can help you understand your potential costs and avoid unexpected expenses.
If you are considering out-of-network care, checking your benefits and understanding how superbills and reimbursement work can help you make an informed decision.
City Lights Psychology offers couples therapy in Flatiron, Manhattan, and virtually across New York, with support for checking out-of-network benefits and navigating reimbursement.
Schedule a free 30-minute consultation with City Lights Psychology to discuss your concerns and learn more about the therapy options available to you.