I encourage you to investigate all options and arrive at an informed decision
regarding your health care before using your benefits.
That may mean using your insurance and it may mean making another choice.
Whatever you choose, I'm here for you!
With the current state of healthcare, you are indeed fortunate to have coverage. Many people feel that therapy is such an expense that they can’t manage without it. If you’re looking for information on using health insurance to cover counseling, you can find a comprehensive overview of what it means for couples and individuals here.
What are the risks of using your health insurance?
The required diagnosis of a mental illness.
Insurance companies only pay for things that they deem to be “medically necessary.” This means that someone has to actually diagnose you with a mental illness and prove that it is impacting your health on a day-to-day basis. Many of life’s problems are not mental health disorders. Many folks seek treatment before their issue would meet criteria for diagnosis as a mental health disorder, which I view as a great thing.
It’s important to remember that simply having symptoms doesn't necessarily mean that you meet the diagnostic criteria for a mental illness.
Understanding What a Diagnosis Means For Your Future
If you get diagnosed with something, you should be able to decide who gets access to that info and why. You lose control of that information when it is in your file being sent to anyone in the health care industry who ever requires access to it.
A diagnosis says nothing about how you cope, what your strengths are, and which of the many symptoms you actually have. But simply having a diagnosis will speak for you and may negatively impact your eligibility for things.
A diagnosis can follow you around in school, on to college, and be a barrier to doing certain things such as working with the military, landing federal jobs, security clearances, aviation, and any other jobs requiring health-care related checks. Many schools and healthcare institutions are now instigating these policies to screen out employees who may be seen as “unstable” or cost too much money in mental health care and lost work days. If your condition warrants a diagnosis, you may want to have some say over how that diagnosis functions in your life now and in the future.
This means that when you apply for new health insurance, life insurance, and many types of jobs, they can require an authorization to release information to view your entire medical record. The average insurance claim passes through 14 people while it is being processed.
Having Coverage Doesn’t Necessarily Mean You’re Covered
An insurance company has several processes to approve treatment. At times, they will only approve a certain number of sessions even if more are necessary.
It should be between you and your therapist to determine what comes next in your treatment and how much of it you need.
But, imagine an insurance agent sitting next to you in your session, clipboard in hand, making decisions about whether you truly “need” this therapy or not.
The rule of thumb when using insurance, directly or by reimbursement, is to contact them before treatment begins and get approved. Ask what information you will need to present for reimbursement.
Be Cautious When An Insurance Company Says They Cover Couples Counseling
They are typically not referring to marital and relationship counseling. They mean that they cover a Procedural Code for a spouse or partner to be present in therapy.
The procedure code tells insurance how the therapy happened - were you seen alone, with your spouse, or other family members? Thankfully, most insurance will cover more than one person being in the room.
However, this gets confusing. So, they will tell you that they cover couples counseling because they will permit your spouse to be in the room with you while you receive counseling for your diagnosed mental health disorder.
Your spouse is being considered a support to you in your treatment. This is typically Procedural Code 90847: “Family psychotherapy, conjoint psychotherapy with the patient present.”
The problem with this is that it isn’t the only thing an insurance company looks at. Treatment not only includes the procedural code, but the diagnostic code.
The diagnostic code tells the insurance company what mental illness the patient is being treated for. This is what they base medical necessity on. The diagnostic code for couples counseling is V-61.10, Relationship Distress with Spouse or Intimate Partner.
This is the code that can be rejected by insurance companies for not being medically necessary.
It’s like trying to get your dental insurance to cover cosmetic whitening or veneers. Insurance companies view relationship problems much in the same way that they view cosmetic procedures – they may be great, but they aren’t medically necessary.
If you want to investigate using health insurance to cover counseling, ask your insurance company if they cover the relational V-Code 61.10, not just “do you cover couples counseling?”
Be specific, because you may not get the answer you need unless you ask about actual code numbers
But Isn't Couples Therapy Expensive?
In truth, most of my couples come to me because they recognize that putting any kind of insurance in charge of the route to saving their marriage can be shortsighted. The investment in a good couples counselor is something that is highly personal.
Some statistics state that the average cost spent on a wedding is $30,381.
Think about that for a moment!
You paid all that money for one day.
The average cost for a divorce in is $17,100.
Comparatively, couples counseling is a small price to pay for an investment in your future!!
So What Insurance Do You Take?
I am an in-network provider for CDPHP.
If you are interested in marriage or couples counseling, please note that CDPHP does not cover V-Code, V61.10. This may change at any time, so I encourage you to call them to inquire about this code. Individuals with any other insurance plan should also contact their insurance to discuss coverage.
But I Don't Have That! Now What Can I Do?
See if your insurance will reimburse you for out of network providers. Though I do not take any insurance other than CDPHP, I am happy to provide you with statements/invoices that many insurance companies require. And if you are denied coverage, I can fill out the necessary forms that they require the provider to complete for the appeals process.
If you are contacting your provider to see about coverage for out of network providers, ask the following:
• How many sessions are covered?
• Do I have to meet my deductible first? Is there an out of pocket maximum?
• Do they require a treatment plan or detailed summary for reimbursement?
• Do they reimburse for V-Code 61.1 (for couples counseling)?
• What are the qualifications required of the therapist? What information do they need from the therapist?
Use Pre-Tax Dollars
Other options include using your Health Savings (HSA) or Flexible Spending Accounts (FSA) to pay for therapy using pre-tax dollars. I do take all types of HSA and FSA cards with major credit logos on them. If you do not have one of these accounts, you could speak with your tax preparer to see if you could deduct therapy expenses from your taxes as an out-of-pocket health expense. Please note that these type of accounts make it harder to get couples therapy covered, so check on that before you begin.
$125 per 50-minute session.
Couples sometimes find that 50-minutes is not enough time to fully address their concerns and may book 80-minute sessions at the rate of $175 per session. 80-minute sessions must be arranged in advance.
I accept cash, check, credit cards, and FSA or HSA with credit card logos. All payments are due at the time of session. Please note that there is a $30 fee on all returned checks.
Missed or Cancelled Appointments
Your session time is reserved specifically for you. If you cancel with less than 24-hours notice or do not show for your appointment, I am unable to fill that time slot with another client. I am also unable to bill insurance for missed sessions. I ask that if clients must cancel any scheduled appointments, they kindly provide a minimum of 24-hours notice. Clients who do not provide 24-hours notice or who are a no show for their appointment will be charged the full session fee of $125 or $175 depending on the amount of session time booked.