More than 15 months of dealing with the coronavirus crisis has left personal relationships frayed. Couples are especially vulnerable right now. So much so that organizations like Westchester County, New York’s Relationships & More are experiencing an increased demand for their services. Many couples are wondering if counseling is covered by their health insurance.
If you are fortunate enough to have insurance coverage for couples’ counseling, you are in the minority. By all means take advantage of it. Couples’ counseling can go a long way toward addressing the unresolved problems brought to light by the pandemic.
If your health insurance doesn’t cover counseling, you are obviously not alone. Yet counseling still may be exactly what you and your partner need. While you think that over, the rest of this post will explain what you need to know about couples’ counseling and insurance.
Standard Health Plans Don’t Cover It
As a general rule, standard health plans do not pay for couples’ counseling. Insurance companies willing to provide the coverage treat it as something extra. Depending on your insurance carrier, you may be able to add the coverage on your own. If you cannot, it’s probably due to the contract your employer has with its insurance carrier. Group contracts do not often allow individual add-ons.
Also understand that health plans designed to comply with the Affordable Care Act (ACA) don’t have to include counseling therapies despite mental and behavioral health services being a requirement under the law’s essential benefits rules.
Why Couples’ Therapy Is Not Included
There are a number of reasons insurance plans do not offer couples’ therapy coverage as a standard benefit. For starters, therapeutic counseling is not considered a treatment for qualified mental health problem. In other words, you and your spouse might seek counseling because your communication problems are leading to nonstop flights. An inability to communicate is not, in and of itself, a mental health issue.
There are two other reasons health plans do not cover couples’ counseling:
- Not Medically Necessary – Health insurance plans are required to cover treatments and procedures that are medically necessary due to a diagnosed injury, illness, or disease. Without treatment, a patient runs the risk of increased injury or death. Counseling is not considered medically necessary. There is no compelling medical reason patients need counseling.
- Not Mental Health Services – Because those who provide couples’ counseling and therapy are not qualified or licensed to provide what are considered official mental health services, there is no requirement for insurance to cover such services. To be as blunt as possible, counselors and therapists are not qualified to diagnose and treat mental health issues.
One possible exception to this general rule is found in the Medicare program. Medicare Part B does cover family counseling as part of treatment recommended by a behavioral healthcare professional. In that regard, couples’ counseling would be covered if offered by a physician, clinical psychologist, clinical social worker, or nurse specialist employed by a Medicare eligible clinic.
If Your Insurance Covers It
On the outside chance that your health insurance does cover couples’ counseling, it may not be as simple as signing at the desk and submitting your co-pay. You may have to meet certain requirements set forth by your insurance carrier. For example, you may have to receive counseling from a clinician rather than a therapist or counselor.
Unfortunately, health insurance plans do not usually cover couples’ counseling. But that should not dissuade you from getting help if your relationship with your partner is in trouble. Couples’ counseling is an invaluable experience well worth paying for.