Does Insurance Cover Couples Therapy? What You Need to Know

Couples therapy has become an increasingly sought-after form of mental health support for individuals seeking to strengthen their relationships. Whether it is to address communication breakdowns, manage conflict, navigate infidelity, or reconnect emotionally, couples therapy can provide a structured and guided path to healing. However, one of the most common questions couples ask before beginning therapy is whether it is covered by insurance. Understanding the scope of insurance coverage for couples therapy is essential for planning and accessing the appropriate mental health services.

The Basic Framework of Insurance and Mental Health Coverage

Most health insurance plans in the United States offer some degree of mental health coverage, particularly following the enforcement of the Mental Health Parity and Addiction Equity Act (MHPAEA). This legislation mandates that mental health benefits should be treated equally to physical health benefits in terms of coverage limitations, copays, and deductibles.

However, couples therapy falls into a gray area. While individual therapy is often covered when tied to a specific mental health diagnosis, coverage for relationship counseling or couples therapy depends on several factors, including:

• The structure of the insurance plan

• The presence of a diagnosable mental health condition

• The therapist’s licensing credentials

• Whether the therapist is in-network

Medical Necessity and Diagnosable Conditions

Health insurance companies typically require that therapy sessions be deemed “medically necessary” to qualify for reimbursement. This means that the therapy must be aimed at treating a recognized mental health disorder, such as:

• Depression

• Anxiety disorders

• Post-traumatic stress disorder (PTSD)

• Substance use disorders

If couples therapy is part of the treatment for one partner’s diagnosed mental health condition, and if the therapy is focused on managing the impact of that condition within the relationship, it may be covered under the individual’s mental health benefits.

For instance, if a partner is undergoing therapy for major depressive disorder, and the therapist includes the other partner in the session to improve support at home and reduce stressors, the session may qualify for coverage under that diagnosis.

Billing Codes and Session Structure

Insurance claims for therapy are processed using specific billing codes. For couples therapy, one commonly used code is CPT code 90847, which refers to family or couples psychotherapy with the patient present. This implies that while both partners are present, the session is considered part of the individual patient’s treatment plan.

It is important to note that if the therapy is focused purely on relationship improvement, conflict resolution, or premarital counseling—without a mental health diagnosis—insurance is unlikely to cover it.

Comparing In-Network vs. Out-of-Network Therapists

The network status of the therapist also plays a role in determining out-of-pocket costs. The table below provides a comparison:

Feature	In-Network Provider	Out-of-Network Provider
Insurance coverage	Usually covered with lower out-of-pocket cost	May be reimbursed partially (if covered)
Need for pre-authorization	Sometimes	Often required
Billing	Provider bills insurance directly	Client may need to submit claims manually
Co-pay or deductible	Typically lower	Typically higher

 

Questions to Ask the Insurance Provider

Before initiating therapy, policyholders are advised to contact their insurance company directly. The following questions can help clarify coverage:

• Is couples or family therapy covered under this plan?

• Are there restrictions on the type of mental health providers I can see?

• Is pre-authorization required before beginning therapy?

• Are there any session limits for mental health services?

• What is the copayment or coinsurance per therapy session?

• Can I submit claims for an out-of-network therapist?

Verifying Therapist Eligibility

For insurance reimbursement to be approved, the therapist must typically hold specific credentials. Therapists eligible for coverage under most plans include:

• Licensed Clinical Social Workers (LCSW)

• Licensed Marriage and Family Therapists (LMFT)

• Licensed Professional Counselors (LPC)

• Clinical Psychologists (PhD or PsyD)

• Psychiatrists (MD or DO)

Therapists must also hold a National Provider Identifier (NPI) and be approved by the insurance carrier to provide billable services.

When Insurance Does Not Cover Couples Therapy

There are circumstances under which insurance will not provide coverage for couples therapy. These include:

• Sessions that are exclusively focused on general relationship enhancement

• Premarital counseling without the presence of a mental health diagnosis

• Therapy conducted by unlicensed or uncertified individuals

• Coaching or religious counseling services

In these cases, the cost of therapy will need to be paid out-of-pocket by the couple.

Alternative Options When Insurance Does Not Cover Couples Therapy

Couples who find that their therapy sessions are not covered by insurance can still explore several cost-effective alternatives:

1. Sliding Scale Fees

Many private practice therapists offer sliding scale payment options based on household income. This can significantly reduce the financial burden.

2. Nonprofit Counseling Services

Community health centers, university psychology clinics, and nonprofit organizations often offer therapy at reduced rates or on a donation basis.

3. Employee Assistance Programs (EAPs)

Some employers offer Employee Assistance Programs that include a limited number of counseling sessions for couples.

4. Online Counseling Platforms

Digital platforms such as BetterHelp, Talkspace, or Regain offer more affordable virtual couples therapy options. However, it is important to verify whether these platforms accept insurance.

Summary of Coverage Scenarios

Scenario	Likely Covered by Insurance?
Partner diagnosed with anxiety; both attend therapy	Yes, if therapy supports treatment
General communication issues without diagnosis	No
Infidelity-related counseling without mental health context	Unlikely
Couples therapy billed under individual diagnosis	Sometimes
Therapy through employer-sponsored EAP	Possibly (limited sessions)

Final Thoughts

Insurance coverage for couples therapy is not always guaranteed and often depends on how the sessions are structured, who the provider is, and whether a diagnosable mental health condition is involved. While mental health parity laws have made individual therapy more accessible, couples therapy still presents unique challenges in terms of reimbursement.

Nevertheless, there are several paths available for couples to seek affordable help, whether through insurance-supported care, sliding scale rates, or community programs. It is advisable for couples to speak directly with their insurance provider and potential therapists to understand the full scope of available options.

Couples therapy can serve as a vital tool for improving emotional connection, navigating life changes, and building healthier communication patterns. Insurance can sometimes support this process, but it should not be the only deciding factor in seeking care. Emotional wellbeing and relational health are worthy investments, regardless of the funding method.