Insurance

In order for you to be able to use insurance to cover any therapy session, there must be a medical necessity for the treatment. When it comes to working with couples, as MFTs we believe that no one person is the problem, but that the problem lies between the two parties, and therefore cannot be pinned to one client in particular. However, sometimes there are issues in the relationship that create mental health challenges for one partner, and doing conjoint therapy is the best way to alleviate those symptoms. Depending upon your situation, we will recommend either true couples work or individual therapy with conjoint sessions. Insurance does not cover couples therapy, only conjoint sessions for an individual who carries a mental health diagnosis. Your clinician can meet with you for an initial appointment and let you know at the end whether or not the diagnosis of the problem would be covered/not covered by insurance. Often, the insurance will cover the initial intake, even with the diagnostic code we use. This does not indicate that they will cover subsequent sessions. We will courtesy bill your insurance again with the diagnosis code we use to establish whether or not they will cover continued services. If that claim is denied, you must pay out of pocket for any continued couples work as your insurance does not cover relational diagnosis. We will only bill and resubmit a claim once per client. We offer a range of fees for couples and family work so that all clients can receive these type of services and we will go over that with you at the initial appointment.

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We use a diagnostic code of Z63.0 for any couples or family therapy sessions where there is not an identified patient who is being treated for a mental health diagnosis. This code is not something we can change just because your insurance tells you it's the wrong code. Most often, the insurance agents who answer customer service calls do not understand that asking the provider to change the code is encouraging insurance fraud. You must ask if Z63.0 is a covered diagnosis with your insurance. If the answer is no, they will not reimburse you for couples or family work. You are always welcome to use an HSA card to pay for couples or family therapy, and we can provide superbills that you can submit to an HSA for reimbursement. You cannot get reimbursement from your insurance company directly for claims that are billed with this code if it is not a covered service.

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It is the client's responsibility to check with their insurance carrier to see if the diagnosis and treatment type is covered by their individual plan. All insurance plans are different, even within the same carrier. We require all couples and family clients, regardless of insurance, to sign paperwork acknowledging that they are responsible for payment should their insurance not pay claims due to the diagnosis not being a covered service.