July 26, 2021

Using insurance for couple therapy

Reconciled couple after effective marital therapy

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In this podcast episode, Elizabeth Polinsky discusses how to use your insurance for couples counseling, including suggestions for military couples wishing to use Tricare insurance.

IN THIS PODCAST

SUMMARY: 

  • Why not all couples therapists take insurance
  • What to do if you find a couples counselor but they don’t take your insurance
  • Insurance requirements if your couples counselor does take your insurance
  • Tips for using Tricare for couples counseling

MAIN POINTS:

1.  Our story with Military OneSource:Our experiences with military one source were not great for premarital couples counseling. They sent us to someone with no experience in couples counseling. She never even asked us what problems we were dealing with or what we wanted to get out of therapy. Military one source may be great for individual counseling, but I tend to think that you should find the couples counselor you want to work with first that is specifically trained inn couples counseling, and then find a way to get it covered by insurance. Our experience of having someone who wasn’t trained in couples counseling really was not helpful. ​

If you can financially do it, go with a therapist that is a good fit even if they don’t take your insurance

Elizabeth Polinsky

2. Why not all couples counselors take insurance

  • If you have some who is trained as a marriage and family therapist, then they are trained from a systems perspective meaning that “no one person is the problem, instead it is how we are interacting together”. Marriage and family therapists believe that “we are both creating whats happening between us and we are both impacted by it”. This is not what insurance companies want to hear; insurance companies want one person to be the problem due to a mental health diagnosis.
  • For your insurance company to pay, they require that the person has a mental health diagnosis and that it is medical necessary for you to have therapy to treat the mental health problem. Additionally for couples counseling, the therapist has to prove that couple therapy can help treat that mental health diagnosis. This is not how couples therapists think because they don’t think one person is the problem.
    1. “There are many people who would love couple therapy who may never meet the requirement for a mental health diagnosis” — Elizabeth Polinsky 
  • If you use your insurance, your insurance company has the right to access all your mental health records. Some therapists prefer to not use insurance in order to enhance confidentiality–especially since there are two people in the session and not just one. By not taking insurance, they can also better protect the confidentiality of the person who is not the “identified patient” with the mental health diagnosis. 
  • Insurance companies often try to dictate treatment as well as the length of therapy instead of letting it be based on what the therapist and the client think would be best. Often times an insurance company will only allow 12 to 24 sessions, and more sessions would have to be approved by the insurance company. The therapist has to give them a summary and a letter of why you absolutely need more couples counseling, and the insurance company could still say you aren’t allowed to have more sessions. 
  • Some insurance companies pay significantly less for couples counseling compared to individual therapy even though couples counseling is way harder and requires specialized training and experience above and beyond just being a therapist. ​

If you are going to pay upfront for couples counseling, ask if there is a military discount”

Elizabeth Polinsky

3. What to do if you find a couple therapist who doesn’t take insurance

  • You may be able to get your insurance company to reimburse you for the services. You would still need a mental health diagnosis for your insurance to reimburse you for out-of -network therapy services. The insurance company may have a different deductible and copay for out-of-network versus in-network therapy services. 
  • If you are going to a therapist who doesn’t take insurance, or who doesn’t take your insurance, tell them you are hoping to get reimbursed from your insurance company and that you would like to be assessed for a mental health diagnosis. A diagnosis has to be in their records on on your bill/ receipt for services in order for the insurance company to reimburse for services. 
  • The receipt that you give your insurance company is called a superbill. Submit superbills to insurance to get partial reimbursement.
    • Reimbursify is helpful for this. There is a small processing fee to use it, and you can do it directly through your insurance company, but I tend to think that reimbusify is just easier to use. 
  • The dual military couples that I have worked with in the past have often chosen to go with a private pay rate for increased confidentiality. Often private pay therapists offer a military discount.  In this option, they do not get reimbursed from Tricare and there is requirement that a mental health diagnosis has to go in the chart. 
  • If there is a civilian spouse with separate insurance other than Tricare, try to use that person’s insurance for couples counseling.” — Elizabeth Polinsky 

4. Things to know if your couples counselor does take your insurance. 

  • You still have to pick one person to carry the mental health diagnosis for the two of you. Think about who is having more anxiety, depression, problems with sleep or eating. Whoever is going through more emotionally, pick them to be the primary patient because it helps the therapist justify a mental health diagnosis and medical necessity. 
  • If one person is in the military and there is a civilian spouse, use the civilian spouses insurance if possible instead of Tricare. This is because:
    • If a couples therapist does take insurance for couples counseling, they might not take Tricare due the fact that Tricare pays lower than other insurances for couple counseling. 
    • If you can find someone who does take Tricare for couples counseling, then they are likely very full and you might have to be on a waitlist to see them. 
Young couple with psychologist family therapy hugging

5. Using Tricare for couples counseling. 

  • If using Tricare, consider making the non-military spouse the primary patient so that way the military spouse does not get a mental health diagnosis in the  health record. Instead, the civilian spouse would get the mental health diagnosis.
    • There is an out-of-network option for Tricare. You can’t just go to any therapist and be reimbursed by Tricare for out-of-network services. You have to go to a certified out-of-network therapist with Tricare in order to receive reimbursement. If you have Tricare Prime, you will need a referral from your primary care doctor.
      • In-network means Tricare pays first and then you might pay a copay.
      • In certified out-of-network, you pay the entire amount up front and Tricare reimburses you either a partial amount or the entire amount.

Actions Steps:Go look up your insurance information and make sure you understand what your insurance covers in terms of mental health treatment, your deductible, your copay, if they cover family therapy (couples therapy is a type of family therapy), and how the rates differ in coverage for in-network versus out-of-network services. 

Liz’s Useful Links: 

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Thanks for Listening!

     

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    About Author

    Elizabeth Polinsky is a Certified Emotionally Focused Couple Therapist (EFT) providing EFT marriage counseling in the states of Virginia, Maryland, North Carolina, South Carolina, Arkansas, and Nevada. She also provides EFT training and supervision to therapists looking to become certified in EFT Couple Therapy. As a military spouse, she has a special passion for working with military and veteran couples, and is also the host of The Communicate & Connect Podcast for Military Relationships.

    DISCLAIMER:

    My podcast, blogs, videos, newsletters, and products are general information for educational purposes only; they are not psychotherapy and not a replacement for therapy. The information provided is not intended to be therapy or psychological advice; and nothing I post should be considered professional advice. The information provided does not constitute the formation of a therapist-patient relationship.

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