Is Marriage Counseling Covered by Insurance? (Spoiler! It’s Complicated!)

Navigating the world of couples counseling can be challenging, especially when trying to understand insurance coverage. Couples seeking support are surprised and often frustrated to find that most couples therapists do not accept insurance for marriage, couples, or any relationship-focused therapy. But why is this the case?

The reality is that insurance companies operate within a system designed for individual mental health treatment, not relational healing. The decision to decline insurance is not about making therapy less accessible; rather, it’s about ensuring high-quality, ethical, and confidential care. From rigid insurance policies to concerns about privacy and autonomy, here’s why many couples therapists choose to remain out-of-network.

Coverage Confusion: Why Insurance Leaves Couples High and Dry

One of the biggest roadblocks is how insurance companies define medical necessity. Most insurance providers only cover treatment for diagnosable mental health conditions, such as depression and anxiety. However, relationship distress, while having the ability to be life-disrupting and utterly devastating, is not considered a billable diagnosis.

As noted With Ours, “Unlike individual therapy, which often falls under mental health care covered by insurance, couples therapy isn’t always seen in the same light. This is because it’s not usually classified under a specific medical diagnosis, making it a grey area for many insurance plans.”

Label or Love? The Dilemma of Diagnosing for Coverage

In order to bill insurance, therapists must provide a mental health diagnosis for at least one partner. This requirement can present ethical concerns:

• Medicalizing Relationship Struggles: It pathologizes issues that are often situational, meaning if the situation is managed or resolved – the diagnosis doesn’t remain. Relationship struggle doesn’t have to be rooted in disorder.

• Inaccurate Clinical Records: It can create an inaccurate clinical record, labeling one partner with a diagnosis they may not truly have.

• Long-Term Implications: A diagnosis can become part of your permanent medical record, potentially impacting future insurance policies or employment screenings.

Marriage.com highlights this sentiment: “Unfortunately, couples and marital problems do not constitute a diagnosis.” Some therapists refuse to assign a diagnosis purely for insurance purposes, as it can be misleading, compromise both the security of the client and the integrity of the therapy

Who’s in Charge Here?

Therapists enter this field to help people- not to be micromanaged by insurance companies. However, insurance policies often dictate:

• What type of therapy is “allowed”

• How many sessions a couple can receive

• Which therapeutic approaches are covered (Gottman vs. EFT, CBT, etc..)

These restrictions can limit the effectiveness of treatment by forcing therapists to fit a rigid insurance model rather than providing personalized care. By working outside of the insurance system, therapists have the ability to offer couples what they genuinely need.

Privacy Please! Why Insurance Companies Might be Peaking into Your Therapy

Couples might assume that therapy is completely confidential, but that may not always be the case when insurance is involved. Insurance companies require documentation of diagnosis, treatment plans, and progress notes, which can be subject to audit and external review.

This raises important questions:

• Do you want a third party to dictate how long or how often you can receive therapy?

• Are you comfortable knowing that personal details of your relationship may be reviewed by insurance administrators?

• Would you rather have complete control over your therapeutic experience without external oversight?

• Could a documented mental health diagnosis potentially have an impact on career, clearances, or professional pathways?

By choosing private pay for couples therapy, couples can ensure that their therapy remains truly confidential – free from insurance scrutiny and unnecessary restrictions.

Why Insurance Reimbursement Doesn’t “Add Up” for Therapists

Even when insurance does cover therapy, the reimbursement rates are often unsustainable for providers (your couples therapist included). Many therapists receive between $40 and 80 dollars from insurance companies despite the expertise, extra time, years of training, and added expense required to master effective couples counseling.

As noted by Thriving Lives Counseling, “The average cost of a therapy session around the country is typically between $100 to $200. With insurance, you may have a copay of $20 -$50. You assume your therapist will bill the insurance company and be reimbursed for the remaining balance. But often, the insurance companies will reimburse for half that amount or less.” This disparity forces some therapists to take on extremely high client loads (sometimes as many as 40 per week), which may lead to burnout for the therapist and the potential for reduced quality of care for the client.

While it may be frustrating to learn that your couples therapist doesn’t accept your insurance, it can be helpful to understand some of the reasons behind this decision. Therapists who choose not to take insurance often do so to provide the best possible care for their clients without being limited by outside regulation or bureaucracy. So, IS marriage counseling covered by insurance? While complicated, hopefully this article has given you a better understanding of why the answer isn't very clear.

References:

1. American Academy of Family Physicians. Patient Confidentiality and Privacy in Healthcare. Retrieved from https://www.aafp.org/pubs/fpm/issues/2025/0300/patient-confidentiality.html.

2. Regency Healthcare Services. Private Pay vs. Insurance-Based Services: What You Need to Know. Retrieved from https://www.regencyhcs.com/blog/private-pay-vs-insurance-based-services.

3. With Ours. Is Couples Therapy Covered by Insurance? Retrieved from https://www.withours.com/blog/is-couples-therapy-covered-by-insurance.

4. Marriage.com. Does Insurance Cover Couples Therapy? Retrieved from https://www.marriage.com/advice/counseling/couples-therapy-insurance-coverage.

5. Thriving Lives Counseling. Why Some Therapists Don’t Accept Insurance. Retrieved from https://thrivinglivescounseling.com/why-some-therapists-dont-accept-insurance.

6. Mental Health Match. The Untold Truth: Why Your Therapist Doesn’t Take Insurance. Retrieved from https://mentalhealthmatch.com/articles/untold-truth-why-your-therapist-doesnt-take-insurance.

7. American Psychological Association. Psychologists Are Burned Out and Overwhelmed, but Still Passionate About Their Work. Retrieved from https://www.apa.org/monitor/2023/04/psychologists-covid-burnout.

8. Business Wire. Over Half of Therapists Have Experienced Burnout in the Past Year, According to SimplePractice Survey. Retrieved from https://www.businesswire.com/news/home/20230929995058/en/Over-Half-of-Therapists-Have-Experienced-Burnout-in-the-Past-Year-According-to-SimplePractice-Survey.