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Why Bethesda Therapy Does Not Accept Insurance for Couples Therapy

You may have noticed that fewer and fewer therapists are accepting insurance for couples therapy, here’s why.

We’re here to provide you with the information you need to make informed decisions about your therapy options. We’d also like to clarify why we’re unable to accept insurance for couples therapy.

Insurance companies usually require three key criteria to cover therapy expenses:

  1. An identified client
  2. A mental health diagnosis
  3. Evidence of treatment directly benefiting both the identified client and the mental health diagnosis

These criteria can typically be met for individual therapy. For instance, if Jamie is attending therapy for generalized anxiety disorder and their therapist uses cognitive behavioral therapy, it clearly fulfills the insurance company’s requirements. The client (Jamie) is identified, the diagnosis is stated (generalized anxiety disorder), and an established treatment method (cognitive behavioral therapy) is used, thereby making it an ethical use of insurance.

Who is the Client?

However, when it comes to couples therapy, these guidelines become less straightforward. In couples therapy, the “client” is the relationship itself, not an individual. As such, there is no clear way for insurance companies to process these treatments since there isn’t an identified client. While some insurance companies may reimburse for “family sessions”, they typically require documentation that supports treatment for a single individual.

What is the Diagnosis?

Another aspect to consider is the diagnosis. In couples therapy, we primarily address “problems in the relationship”, which carries a specific code (Z63.0). However, insurance companies generally do not cover this code.

You might wonder, if you or your partner meet the diagnostic criteria for a covered condition such as generalized anxiety disorder, could that diagnosis be used to bill insurance for couples therapy? Unfortunately, the answer is no. In couples therapy, our focus is on improving the dynamics of your relationship, not directly treating individual disorders such as generalized anxiety disorder.

So, why do some therapists accept insurance for couples therapy?

The answer varies. Some therapists might bill insurance for couples therapy because they are treating an individual diagnosis, with the partner involved primarily for support. Others may interpret insurance regulations differently and believe that they are acting within those guidelines. Still, others may view the therapeutic value of couples therapy as sufficient justification for using insurance, even if it requires designating one partner as the “client”.

Our Policy

After careful consideration and consultation with insurance providers and respected peers in our field, we have decided that ethically, we cannot bill insurance for the couples therapy we offer. We respect that other therapists and practices may arrive at different conclusions.

We understand that this is a lot of information to digest! If you have any questions or need further information about couples therapy sessions and costs, please do not hesitate to reach out. We’re here to help you navigate your therapy journey.

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