*More Information about Insurance and Couple/Family Therapy

I have looked deeply into the question of how to bill insurance for couple/family therapy, as it is an area of legal and ethical confusion in the field. What I have found is the following:

Couple and Family therapy will only definitively be covered by insurance when the purpose of therapy is to support the covered member with managing symptoms of a mental health diagnosis, with the other person(s) acting as a “collateral” or support person. This looks like the covered member’s symptoms needing to be focused on for the majority of time in treatment - in other words, there is an unequal focus on one person over the other.

Conversely, traditional or systemic couple/family therapy looks like the therapist treating the relationship as the client, with an equal emphasis on all parties’ needs, symptoms, and concerns. In traditional couple/family therapy, a therapist can’t arbitrarily pick one person to be “the client” while doing therapy with all people present. As a licensed marriage and family therapist, I have been advised that unless there is a diagnosis being treated with medically necessary evidence-based treatment and collateral support, singling out one person as “the client” is unethical.

All of the above creates a conflict with insurance: when the primary purpose of therapy is to improve the relationship, with equal emphasis on all parties, and without the primary goal of treating symptoms of a diagnosis, the services are referred to as “enrichment counseling” and are not considered medically necessary.

For this reason, I am unable to guarantee any couple or family can use their insurance prior to completing a consultation and intake with me, as billing for services that are not considered medically necessary could result in the insurance company recouping their payments from me and potentially even charging me with insurance fraud.

The initial consultation is always free. I bill the intake to the covered member’s insurance if medical necessity is determined. If medical necessity is not determined, I charge a flat fee of $100, which can be negotiated lower if need be. For Medicaid clients, the screening assessment is free per OHA laws.

Completing an assessment is not a guarantee of treatment coverage - through the course of the assessment we may find that medical necessity has not been met, in which case you will need to proceed using an insurance waiver and pay out-of-pocket.