If you’ve ever searched for a couples therapist who accepts insurance, you may have found that it’s surprisingly difficult. Unlike individual therapy, which is often covered by health insurance, many therapists who specialize in couples therapy operate on a private-pay basis. While this can be frustrating for couples hoping to use their insurance benefits, there are important reasons behind this common practice. Understanding these reasons can help you make informed decisions about your care.
1. Insurance Companies Reimburse Less for Couples Therapy
One of the main financial barriers to accepting insurance for couples therapy is that insurance companies often pay significantly less for these sessions compared to individual therapy. On average, insurers reimburse about 30% less for couples therapy sessions than they do for individual sessions. Given that couples therapy often requires specialized training and a higher level of expertise to navigate complex relational dynamics, this lower reimbursement rate makes it financially unsustainable for many therapists.
2. Insurance Requires a Mental Health Diagnosis
Another major reason couples therapists don’t take insurance is that insurance companies require a diagnosis of a mental health disorder to justify payment. This means that in order for insurance to cover therapy, one partner must be diagnosed with a condition such as anxiety, depression, or PTSD.
This presents ethical and clinical challenges because couples therapy is fundamentally about the relationship, not just one individual’s mental health. If a therapist is required to center therapy around one partner’s diagnosis, they are forced to shift the focus away from the relational dynamics that brought the couple into therapy in the first place. This can lead to:
A distorted focus where therapy becomes about treating one partner rather than working on mutual relationship concerns.
Unnecessary or inappropriate diagnoses to satisfy insurance requirements.
A lack of insurance coverage for couples who don’t meet the criteria for a mental health diagnosis but still need help.
3. Ethical and Legal Concerns in Couples Therapy
Taking insurance for couples therapy can also raise ethical issues that therapists must carefully consider. These include:
Confidentiality & Record Keeping: When insurance is billed, the therapist must provide clinical documentation, which includes the diagnosis and treatment plan. If the insurance company audits the file, they may have access to sensitive details about the couple’s relationship, which can be an invasion of privacy.
Who is the Client?: Insurance companies require the therapist to designate one partner as the official “client” with a mental health diagnosis. This creates a power imbalance in therapy and can undermine the neutrality essential for effective couples work.
Medical Necessity vs. Relationship Work: Insurance is designed to cover medically necessary treatment. Since relationship distress is not classified as a medical condition, sessions must be framed around an individual’s symptoms rather than the couple’s needs. This can compromise the integrity of the therapeutic work.
4. Time and Administrative Burdens
Working with insurance companies often requires a significant amount of time spent on paperwork, submitting claims, handling claim denials, and communicating with insurance representatives. This administrative burden takes away time that could be spent on providing therapy or professional development. By opting out of insurance, many therapists can offer better care without the stress of bureaucratic hurdles.
The Benefits of Paying Out-of-Pocket for Couples Therapy
While private-pay therapy can be an investment, it also comes with significant advantages:
More Effective Therapy: Couples therapy remains focused on relational issues rather than being constrained by insurance guidelines.
No Diagnosis Required: Neither partner needs to be labeled with a mental health disorder for therapy to proceed.
Greater Privacy & Confidentiality: No insurance records mean greater protection of personal relationship details.
More Flexibility: Therapists can tailor their approach and session length to best serve the couple, rather than adhering to insurance-mandated models.
What Are Your Options?
If you’re concerned about the cost of couples therapy, here are some alternatives to explore:
Health Savings Accounts (HSA) or Flexible Spending Accounts (FSA): Many couples use these pre-tax funds to help cover therapy costs.
Sliding Scale Fees: Some therapists offer reduced rates based on income.
Nonprofit Counseling Centers: Some community organizations offer lower-cost couples therapy services.
Self-Pay & Superbills: Some therapists can provide a superbill that you can submit to your insurance for possible out-of-network reimbursement.
Final Thoughts
While it may seem frustrating that so many couples therapists don’t accept insurance, these decisions are often made to preserve ethical integrity, ensure financial sustainability, and provide the best care possible. If you’re seeking couples therapy, understanding these factors can help you make an informed decision about how to invest in your relationship’s health and well-being.
