Using insurance for couples therapy

Episode Summary of “Using insurance for couples therapy”

Welcome to another informative episode of the Communicate and Connect Podcast for Military Relationships with your host, Dr. Elizabeth Polinsky! Today, we’re tackling a crucial topic that often confuses many couples — using insurance for couples therapy. Dr. Polinsky, a military marriage counselor passionate about helping relationships thrive, dives deep into the complexities of insurance coverage for therapeutic services.

In this episode, she addresses why not all couples therapists accept insurance and provides actionable advice on what to do if your chosen therapist is out-of-network. Dr. Polinsky also breaks down the intricacies of using Tricare for military couples, sharing tips on maximizing benefits and ensuring confidentiality. Drawing from personal experiences and professional insights, she emphasizes the importance of finding a therapist that both partners connect with, even if it means navigating a bit of insurance red tape.

Dr. Polinsky offers a step-by-step action plan for understanding your insurance coverage, including details on deductibles, co-pays, and whether your plan covers family therapy. Whether you’re part of a military family or simply looking to improve your relationship, this episode is packed with valuable information to help you navigate the often confusing world of insurance for couples therapy. So, grab a notebook and get ready to learn how to make your insurance work for you and your relationship.

Don’t forget to check out our free 10-week relationship email course! Let’s get started!

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Episode Transcript for “Using insurance for couples therapy”

Dr. Elizabeth Polinsky [00:00:01]:
This podcast is sponsored by Communicate and Connect Counseling, where we have a team of therapists who provide individual, couples, and family therapy services, all tailored to meet the needs of military and veteran families. To learn more about our services, visit www.communicateandconnect.com.

Dr. Elizabeth Polinsky [00:00:27]:
Welcome to the Communicate and Connect Podcast for Military Relationships with your host, Elizabeth Polinsky, a military marriage counselor. If this is your first time listening to the Communicate and Connect podcast, please take a second to go, rate, review and subscribe to make sure you get all our future episodes.

We also really want to know what it is you love about our podcast, and if for some reason you’re not loving it, we want to know that too, because we’re committed to providing the best quality content to help you improve your relationships.

Dr. Elizabeth Polinsky [00:01:04]:
This is episode 20 on how to use Insurance for Couples Therapy.

hey everyone. So I really wanted to talk about this topic of how to use your insurance for couples therapy. This is something that I feel pretty passionately about and it’s also something that I get a lot of questions about, especially with tricare and military couples, which I’ll talk about as well.

But in this episode I really want to talk a little bit about why not all couples therapists take insurance. What to do if you find a couple therapists that you really want to work with but they don’t take insurance in general or they don’t take your insurance, what to do in that situation, and also how to navigate your insurance if your couple therapist does take your insurance.

And that’s when I’ll talk a little bit more about tricare. This is particularly important to me, I think, because my husband and I, when we were doing premarital couples counseling, we used military onesource and I know a lot of people who love military OneSource and I think, you know, it has the potential to be very helpful for individual counseling. I’ll just say, like our experiences with Military one source were not that great.

Dr. Elizabeth Polinsky [00:02:36]:
We were sent to a therapist who had never done couples counseling before and who predominantly worked with kids who were involved in foster care and CPS cases. And so that was concerning for us. We worked with her for a little bit and not once did she ever ask us what problems we thought we might be dealing with or what we were hoping to get out of couples therapy.

And so this was just really shocking that that is what Military OneSource sent us to for premarital couples counseling. And yeah, we didn’t stay very long with her because she didn’t have any training in couples therapy and was not really helping us even navigate conversations. So I tend to think that military onesource is probably not the best option unless you can find somebody who is a marriage and family therapist.

I think it’s just so much easier to try to use your health insurance and find a therapist that is somebody who does couples therapy, and it isn’t just a side job or a, I don’t know, hobby. Find somebody who actually does couples therapy, and that’s what they do.

Dr. Elizabeth Polinsky [00:04:01]:
So let me start talking a little bit about why not all couples therapists take insurance. And so there are four reasons why couples therapists don’t take insurance.

One is because, especially if you have someone who’s trained as a marriage and family therapist, which is always what I would recommend, marriage and family therapists have a systems perspective, which means that they are coming to the relationship as thinking about it, the problem being in how you are relating to each other. So no one person is the problem. Instead, it’s how we’re interacting together.

So we both are helping to create what’s happening between us, and we’re both impacted by what’s happening between us. And this is really different than what an insurance company wants to hear. Your insurance company wants to know that there’s one person who has a mental health diagnosis that you are helping to treat and make better and help them no longer have a mental health diagnosis in order to do therapy and for them to pay for services.

Couples therapists prioritize relational dynamics over diagnosis.

Dr. Elizabeth Polinsky [00:05:20]:
So a lot of couples therapists don’t even think in terms of a mental health diagnosis. They think in terms of how is there a system in between the two of you? How are you both relating? No one person has a problem or is a problem, and that doesn’t always jive very well with insurance companies.

The second reason why couples therapists often don’t take insurance is because for your insurance company to pay for any mental health services, you have to have, one, a mental health diagnosis, and two, what’s called medical necessity.

So the therapist has to be able to say, yep, you meet, you know, XYZ criteria for this mental health diagnosis, and not only do you meet that mental health diagnosis, but you also have impairment in your social functioning, in your work life, in your family life. Like, they have to go through and say, yes, there’s a mental health diagnosis, and it is causing so much problems that it’s medically necessary for them to be in therapy.

On top of that, not only does there need to be a mental health diagnosis that’s medically necessary for therapy, but couples therapy needs to somehow be connected to that mental health diagnosis. So the therapist then has to justify that couples therapy can be used to treat the mental health diagnosis of the individual. So this, again, is just really not how couples therapists even think.

Couple conflicts stem from relational dynamics, not individuals.

Dr. Elizabeth Polinsky [00:07:04]:
They say, no, no one person is the problem. It’s how these two people are relating together that is causing all of this conflict. And on top of it not being how couples therapists often think about the problem in relationships, there are so many people who would love to have couples therapy, but who may never qualify for a mental health diagnosis and may not want to receive a mental health diagnosis, but it would be required in order to use your insurance.

The third reason why not all couples therapists take insurance is because your insurance company, in exchange for you using your insurance, your insurance company then gets the right to view all the records so they have access to your diagnosis. They can come talk to me or another therapist and say, we want to see your treatment plan. We want to see your progress notes. We want to see all of this information about the client.

And so oftentimes, couple therapists feel a lot better about confidentiality, Especially because there are two people involved in the process.

Dr. Elizabeth Polinsky [00:08:14]:
By just not going with insurance, that helps keep things very confidential from the insurance company. The fourth reason why couple therapists tend to not take insurance is because insurance companies often end up trying to dictate treatment, Specifically the length of treatment.

So I could talk more about this in terms of individual therapy. I used to do more individual therapy before I. Before I did couples counseling. And there were often times where an insurance company would give somebody 12 sessions, maybe, maybe up to 24 sessions. But at that point, I had to write a letter requesting more sessions. So.

Dr. Elizabeth Polinsky [00:09:03]:
And they can. They can decide, no, this person doesn’t need any more sessions. But in that letter, you have to give all of this information. You have to say the mental health diagnosis, how it’s impairing them, Give them a kind of a summary of the problems and why somebody absolutely needs more therapy.

And the insurance company can come back and say, no, we’re not going to approve more therapy sessions. These are really the reasons why couples therapists don’t always take insurance. On top of the fact that, depending on the insurance company, insurance companies tend to.

Some insurance companies actually pay therapists significantly less for family therapy and couple therapy than they do for individual therapy, which is actually kind of a big deal.

Dr. Elizabeth Polinsky [00:09:55]:
I have one insurance company that pays me half the rate of. Half of my rate for couple therapy and half of what other insurance companies pay me for the same thing. So this can be really challenging because also therapists have to pay their own bills. Okay, so what to do?

If you find a couple therapists, but they either don’t take insurance or they don’t take your insurance, you can still get your insurance to likely pay for your, for your therapy. And so I always tend to think that if you can financially do it, then I would go with a therapist that is a good fit over somebody who takes your insurance. So I’ll explain how this works.

So you still need a mental health diagnosis. The therapist that you see, even if they don’t take your insurance, they have to put a mental health diagnosis in your record.

Dr. Elizabeth Polinsky [00:10:57]:
So make sure that on, make sure that they do that for you. Because when you get a receipt, which is called a super bill, we call it a super bill, but it’s just a fancy invoice receipt. It lists your mental health diagnosis on it and the therapy code that was used.

And then you can take that receipt and give it to your insurance company. And if you have out of network coverage, then they will reimburse you for that. Now oftentimes insurance companies have a different deductible and a different co pay for out of network services compared to in network services.

But again, I tend to think that it’s so important that you and your partner click with your therapist that I would often suggest going with a therapist that you click with even if they don’t take your insurance. So let’s say that you get a super bill and you want to submit this to your insurance company to see if they will reimburse you.

Dr. Elizabeth Polinsky [00:12:08]:
There is a website and there’s also a phone app called Reimbursify. This is what I tend to recommend to people who decide they want to work with me even if I don’t take their insurance, because that can be, that’s just a really convenient way to do it. There is like a processing fee I think, to use Reimbursify.

So if you wanted to avoid that, there should be a way to do it directly through your insurance company, through the portal that you log into. If you just wanted something really easy, then I always recommend Reimbursify. So when it comes to dual military couples, I’ll say they tend to, they tend to choose to go with a private pay therapist just to increase confidentiality.

I would say a lot of therapists who don’t take your insurance their private pay. And so then you have to pay the private pay rate if they don’t take your insurance.

Military discounts: select primary patient for therapy.

Dr. Elizabeth Polinsky [00:13:06]:
They often offer military discounts. So if you are thinking that you’re just going to pay upfront for therapy services and couples counseling and not use your insurance and not try to get reimbursed by your insurance, then I would definitely ask if there is a military discount.

So how to navigate it? If your couple therapist does take your insurance, you still have to pick one person to carry the mental health diagnosis for the couple. So of the two of you, I would think about who has more anxiety, who has more depression, who is having trouble sleeping, who’s having trouble eating. These types of things are great signals that maybe somebody is having a mental health concern at that time.

And so whoever seems like they might be going through more emotionally, you want to pick them to be the primary patient because then it’s easier for the therapist to justify a mental health diagnosis. Now, if you are in the military and you’re using Tricare, but one of the military spouses is a civilian, I would say pick the non service member, have the military spouse, not the military service member, be the patient. That way you guys can be seen as a couple for couples counseling.

Military mental health overshadowed: Seek alternative insurance.

Dr. Elizabeth Polinsky [00:14:40]:
But the military member never gets a mental health diagnosis because the civilian spouse gets a mental health diagnosis. And then the service member is not connected to anything. They don’t get a diagnosis, they’re not associated with it, just the spouses.

If your spouse, if the civilian spouse has insurance that is separate from Tricare, then you probably want to see if that insurance company takes, if there’s, if there’s a therapist that takes that insurance, the insurance that your spouse brings to the relationship and see if there’s a therapist that does couples therapy who takes that insurance. This is just because Tricare is one of the insurance companies that pays a lot less for couples therapy than for other forms of therapy.

So a lot of therapists, if they do take insurance for couples therapy, they might not take Tricare. If they do take Tricare, then they’re probably very, very full. If you’re spouse, if the civilian spouse has a secondary insurance, try to use that if possible or try to get on a wait list for somebody who does take Tricare.

Dr. Elizabeth Polinsky [00:16:06]:
So these are the biggest things that you need to know about how to get your insurance company to cover couples therapy.

Here is my action plan for you. The thing that I really want everyone listening to this episode to go home and do is to go look at your insurance and figure out what it covers in terms of mental health treatment. Figure out, do you have a deductible?

I’ve had some people who didn’t have any deductible they don’t have to. They don’t even have a copay. They pay $0 for therapy using their insurance. And then I’ve had other couples who have had a deductible that was a couple thousand dollars and they had to pay that before their insurance would cover anything. Same thing with copays.

Dr. Elizabeth Polinsky [00:16:54]:
I’ve had people who have had very small co pays and people who’ve had larger copays. So these are things that you want to know and you want to know is it different for going with somebody who’s in network with your insurance or somebody who’s out of network with your insurance.

You want to also figure out do they cover family therapy or do they only cover individual therapy? You want to make sure that they cover family therapy if you are going to try to use your insurance for couples counseling.

One last thing that I forgot to mention about Tricare is there is an out of network option for Tricare. You can’t just go to any therapist like if I. They have to be certified by Tricare as an out of network provider. So they have to be sort of Tricare approved as an out of network provider. The difference between that is an in network.

Dr. Elizabeth Polinsky [00:17:53]:
An in network Tricare provider submits the claim to Tricare directly and then if you owe copay or something then you pay that. But then Tricare pays everything else. A certified out of network Tricare provider is someone where you pay for everything first and then Tricare reimburses you.

So maybe you pay, I don’t know, just for. I have no idea how much it would cost. So this is just for ease of numbers. Let’s say you pay $100 and then the therapist submits a claim to Tricare and then tricare reimburses you $70 or something like that. Maybe it’s.

Dr. Elizabeth Polinsky [00:18:38]:
Maybe they reimburse you the whole thing. That is something that’s worth finding out with your insurance company. So there is a way to do the sort of super bill out of network reimbursement with Tricare as long as the therapist is a certified out of network provider with Tricare.

Just as a final thought, what I want everyone to do is go find out about what your insurance covers for mental health. What’s your deductible, what’s your copay? Are they different for in network versus out of network and does your insurance cover family therapy? Thanks for listening.

Dr. Elizabeth Polinsky [00:19:24]:
I hope you enjoyed today’s episode. If so, please take a second to go rate, review and subscribe. So you get all of our future episodes. Make sure to check out the show notes to sign up for our free 10 week relationship email course.

This email course is really designed for people who are maybe having trouble with communication or connection in their relationship and helping them develop some quick wins right away to start improving it. While I am a therapist, this podcast is for educational purposes only and is not considered therapy and it should also not be a replacement for therapy. If you think you need a professional of any kind, you should definitely go find one.

Until next time.