Uncovering the Mystery of Insurance Coverage for Couples Therapy and Family Therapy

I like a good detective story, but no one told me that I would become self-trained in the mysteries of health insurance coverage.
As a psychologist, I'm educated and experienced in providing individual, couples and family counseling.
I love doing it and I'm happy to accept insurance as part of my payment. So here is what I've discovered in my side career as an insurance sleuth.

Health Insurance coverage is based on a medical model known in your insurance contract as "medical necessity".
The medical model is: an individual is sick, goes to a doctor, receives a medical diagnosis and treatment for the symptoms of that disorder The doctor is reimbursed for the treatment provided minus the copay.Unfortunately, this model doesn't fit couples and family therapy very well at all.

First Problem: health insurance reimbursement is based on the individual's medical disorder.The insurance community has no way to define a couple or family as having a reimbursable medical disorder. For example, an individual can have an anxiety disorder, depression, obsessive compulsive disorder, but a couple cannot be diagnosed this way.

While couples and families may be experiencing life stressors and relationship problems that cause significant conflict and dissatisfaction, these are not medical symptoms or a reimbursable mental disorder .
Clearly, poor communication skills, problems with negotiating decisions, difficulties with compromising, or understanding the emotional or psychological needs of a partner, spouse or family member can all be addressed by counseling,

Unfortunately, they are not considered "medically necessary" problems by the health insurance community.As a result, couples therapy and family therapy generally do not qualify for health insurance coverage because they are not reimbursable services as defined by the health insurance company's rules and regulations.


Second Problem: while health insurance companies will reimburse doctors for preventative physical health care (i.e., annual physicals, Pap smears, mammograms, teeth cleaning), they do not cover any preventative care services for mental health.
As a result, health insurance will only cover psychologists for services once you have a mental disorder condition, not to prevent one.

So, dear readers, that is the sad story for now.
Hopefully, in the future, there will be greater enlightenment in the health care insurance industry about the value of covering a wider variety of counseling services for folks who are not yet so stressed as to be "ill".

Until then, couples and family therapy is an "out of pocket" expense for interested clients.

*********Now for the good news!
Effective couples therapy and family therapy is not a weekly expense, Sessions are scheduled once to twice a month.
Effective couples therapy and family therapy can be targeted for maximum impact. Specific skills and issues can be identified and worked on with an intensive approach.
Effective couples therapy and family therapy CAN MAKE A DIFFERENCE to relationships within a few sessions.

Until next time, please take good care, one and all!