Why I will not bill your insurance company for marriage counseling
Relationships are work, and marriages take even more work. Maybe you were lucky enough to be told this early on, but for many it is a surprise. This is not where you expected your marriage to be, months, or years later.
Have your or your partner said any of the following? “I can’t take this anymore,” “I’m done,” “I don’t need this,” and so on. Most likely, you are saying these things in the heat of the moment, and you later apologize or move on. This type of relationship stress is not abnormal and relationship dynamics in marriages create a space in which rational thinking can sometimes go out the window.
By the time couples reach out to a marriage counselor, conflict is constant and oftentimes the couple feels very disconnected. The couple begins to believe their partners do not care about the, do not listen to them and do not respect them. Those little things that you thought we so endearing at the beginning of the relationship are now downright aggravating and annoying.
Marriage Counseling is hard for the therapist too!
I have to listen to and respect both of you — even when your throwing insults and criticisms at each other. I need to remain unbiased and fair and hear both sides of the argument. I have to translate criticisms into requests and help you break the cycle of negativity. I hold the hope for both of you even when to do not. Sometimes, it’s like sitting in the front row of a boxing match. There are times when I wonder if the couple realizes they are paying me to be a witness to their arguments for an hour a week. I imagine what it must be like in the households and what the children are experiencing if Mom and Dad can’t come together for one small hour each week.
Marriage counseling, while rewarding, is also exhausting for the therapist. It takes a lot of mental fortitude and patience. It is more difficult to deal with two people’s long-standing patterns and behaviors than to work with an individual client.
With marriage counseling, couples are coming to us in crisis. These are the worst times and neither are presenting much of their rational selves. They often come to session ready to prove the other is wrong and that they are right. As a couple’s therapist, I have to be onguard and try and stay ahead of the storm. This is intricate, delicate work. Because whatever happens to any of us in the room, impacts the others.
What does this have to do with your insurer?
Most health insurance companies do not consider “relationship distress” to be a health issue. This means they do not reimburse for counseling for any type of relationship problem – even for couples with children and the couple’s discord in affecting their children.
Honestly, I think they should. A bad relationship affects mental health. I think the two are intricately linked. We know that illnesses are exacerbated by stress. And when your relationship is not going well, and there is disconnection and conflict, there is also more stress. At the end of the day, I believe the health insurance companies would save money if they were willing to pay for marriage counseling.
Unfortunately, I do not make the rules. Health insurance companies pay the bill, so they get to define what is medically necessary and what is not.
Yet the public seems to believe that marriage counseling is a covered benefit from their health insurance company since it is a type of therapy/counseling. Additionally, because this is a grey area, many therapists will find a way to bill for these services. But I will not, and here is why:
It is fraudulent to write “marriage counseling as medically necessary” for reimbursement.
The unique circumstances in which insurance companies will pay for a couple to be in the session together are very limited. Such as when one person (the primary patient) is seeking psychotherapy for their depression or anxiety, and once in a while, their partner comes in to sessions to help their loved one with their anxiety, depression, or another medically necessary diagnosis. Some therapists will write this up as one patient in the room, regardless of how frequently they both attend.
This “once in a while” scenario is vague as defined by insurers. However, in my definition, if we talk about anything other than the primary patient’s depression or anxiety, it is relationship counseling.
In my definition, I’d say this could legitimately be written up for the insurance to pay if their partner came in maybe once every 3-6 months.
On a side note, there are insurance companies (a lot of EAP’s) that will reimburse for the dx code of Z63.0 (Relationship distress with partner or spouse).
I will not bill insurers for your relationship/marriage counseling sessions unless it is specifically called out by your insurance company as covered
Because the public is misinformed about this, and because our insurance benefits provide us with counseling that we otherwise might not be able to access, and everyone wants to use their health insurance, many people are surprised to find out that marriage counseling is not covered under their policy.
People call my office and say things like:
The insurance company said it depends on how the provider writes it up
I’m covered for counseling, I checked
Can you write it up in a way I will be covered?
I know there are other clinicians who do all of the above, but I am strict about this. Billing your insurance for marriage counseling, unless it is specifically stated that it is covered (Dx code Z63.0), is fraudulent. I will not bill your insurance and risk insurance fraud and other legal issues.
Therapy is not cheap. But it is cheaper than divorce or separation. The investment in your relationship and your wellbeing will bring you far greater value than any other material items.