Does My Healthcare Insurance Cover Couples Counseling?
If you're seeking help for a troubled relationship (marriage, engagement, committed dating) be aware that this will be considered your "diagnosis." The diagnosis code "Z63.0 Partner Relational Problem" will appear on the receipt that you will submit to your insurance company for reimbursement.
Insurance companies only pay for treatments that are “medically necessary.” You must receive a specific diagnosis of a mental health disorder (e.g., depression, anxiety, OCD, etc.) that is negatively affecting your health on a day-to-day basis. Most relationship problems are not mental health disorders.
Be savvy as you research this matter. You are expected to understand what your health insurance policy covers and what it does not cover. Many policies state that they will pay only for treatment considered to be “medically necessary.” They have the right to withhold payment if a treatment is considered outside the scope of coverage. It’s like trying to get your dental insurance to cover cosmetic whitening or veneers. It is not going to happen. Insurance companies view the treatment of relationship problems much in the same way that they view cosmetic procedures: it may be greatly beneficial, but it isn’t "medically necessary."
What If I Get a Diagnosis?
If you have symptoms consistent with a mental health diagnosis, the treatment will focus on the mental health disorder and not on the relationship. The other person (your partner) will attend the sessions solely in support of you, for counseling that is focused on your mental health disorder. Obviously, no marriage counseling is possible under this scenario, and it is unethical to call it anything else just to make it medically necessary. To do so would be committing insurance fraud.
What Are the Drawbacks of a Diagnosis?
Anything that is part of your treatment becomes a permanent part of your healthcare record. When you apply for new health insurance, life insurance, and many types of jobs, you may be asked to provide an authorization to release information to view your entire medical record. With health care reform, being denied coverage due to a preexisting condition is less of an issue; however, insurance companies can charge much higher premiums if you have ever been treated for a mental health disorder.
The mental health diagnosis is not the only thing that becomes part of your file. Insurance companies require treatment plans, progress reports, and all of your personal information to determine medical necessity and what, if anything, they will cover. These details about your treatment should be private, but instead they will be open and available to anyone with access. This could include potential employers. It is reported that the average insurance claim passes through and is viewed by 14 people while it is being processed.
What Else Can I Do?
- Check if your insurance will reimburse you for out-of-network providers (see the information about out-of-network on this page.)
- Use pre-tax dollars in your Health Savings Account (HSA) or Flexible Spending Accounts (FSA) to pay for therapy. Dr. Z accepts all HSA and FSA cards with major credit card logos on them. Please note that the same rules for coverage may apply to HSA and FSA account: check with your insurance company before you begin using them for treatment other than "medically necessary," i.e. for relationship counseling.