The decision to pursue couples therapy with your partner involves a number of factors — from coordinating schedules to finding someone that works well for both of you. One of the last things you want to spend your time on is navigating the finances of couples therapy, especially when it comes to insurance. However, it is important to know what to expect. The truth is that mental health care can be a significant cost, and the world of insurance is complex and at times, baffling. The important thing to keep in mind is that therapy is an investment in yourself and your relationship.
At Two Chairs, we’re here to support you and your partner through the complexities of paying for Couples Therapy. That way, you and your partner can spend your time focusing on your relationship.
Do insurance plans cover Couples Therapy?
The good news is that most insurance companies cover couples therapy if either you or your partner, the identified patient (IP), has a diagnosis. On the flip side, insurance companies are unlikely to cover therapy for marriage counseling or counseling where there is not an IP with a clinical diagnosis (i.e., if the services provided are not deemed ‘medical necessity’). The coverage available will depend on the insurance benefits of the IP.
To determine if you or your partner’s plan covers Couples Therapy for visits at Two Chairs, and what that coverage is, you’ll want to call your insurance company and ask about the details of your specific plan by following these steps:
Step 1: Call the Member Services number located on the back of the IP’s insurance
Step 2: If given the option, say you’d like to discuss “Benefits”
Step 3: Ask for out-of-network coverage for CPT code 90847 for an individual with a diagnosis
We currently charge $225 per session. Understanding what portion your insurance company covers should give you an idea of what your out-of-pocket expenses will be for each session.
What will determine who the IP will be? Who will determine the diagnosis?
At Two Chairs, your Couples Therapist will help to determine who the IP is based on the presence of a clinical diagnosis. The IP, by definition, must have a clinical diagnosis. If your clinician determines that both individuals reasonably have clinical diagnoses, then it is up to you all to determine whose insurance you would like to submit to. Because this information won’t be available until after your first session, it may be a better use of your time to call the insurance company after you’ve had your first session.
How do I utilize the benefits of the insurance plan for Couples Therapy?
In order to receive reimbursement for out-of-network care, insurance claims will need to be submitted to the plan that covers the IP. If you’re self-submitting your claims, you’ll typically need an itemized bill from your therapist. You should then be able to use your insurance company’s online Member Portal to fill out an electronic form, attach the itemized bill, and submit the claims online.
For most major insurance companies, Two Chairs can actually submit the claims on your behalf, sparing you the time and paperwork. You’ll also have access to the Care Coordination team, who can answer any questions you may have and can provide you with additional insurance support.
What if we’re covered under two plans?
If the IP is covered by more than one plan (e.g., they have their own plan and are also a dependent on their partner’s plan), you do have the option to submit claims to both plans through a process called “coordination of benefits”. Check out this article for more information on coordination of benefits.
It is important to note that you cannot ‘double-dip’ and submit a claim to both plans for the same appointment. Additionally, if you pursue care with Two Chairs, it is important to note that we can submit only the first claim on your behalf. Any submission of claims to secondary insurance plans will need to be self-submitted.
Why does a couples session cost more than an individual session?
The cost for a session of Couples Therapy is often higher than the cost for an individual therapy session. While the length of time for couples counseling is the same length as an individual session, the higher cost accounts for the complexity of having two people in the (virtual) room. Couples Therapy also requires additional documentation and client management, which requires more time for administrative work.
The Care Coordination team at Two Chairs is here to help
The decision to begin couples counseling is an important step in your relationship, and the complexities of insurance can make that decision even more difficult. As you’re getting started with Couples Therapy at Two Chairs, the Care Coordination team is here to guide you through the process. We’re available by phone or by email to answer any questions you may have, and to support you and your partner through your mental health journey.
For more information about the nuts and bolts of insurance and therapy, check out our article on How Much Does Therapy Really Cost?
If you or someone you know is seeking mental health care, you can reach out to our Care Coordination team at [email protected] or by phone at (415) 202-5159.
If you or someone you know is experiencing an emergency or crisis and needs immediate help, call 911 or go to the nearest emergency room. Additional resources can be found here.