Is Marriage Counseling Covered by Health Insurance?

It’s not cheap to undergo marriage counseling, but for couples eager to save a marriage, this may be their only recourse. Also called couples counseling, this form of talk therapy helps partners “recognize and resolve conflicts and improve their relationships,” according to the Mayo Clinic definition. Credentialed specialists are expensive, particularly if long-term counseling is required. Some couples may be able qualify for insurance reimbursement but only under very limited circumstances.

Typical Costs

Marriage counseling is not a “one size fits all” science. Some practices bill by the hour or the session. Many marriage counselors employ a sliding fee scale, basing therapy cost on household income. “Since most marriage counselors see couples one session a week for the first three months, you can expect to pay about $1,200” if billed at $100 an hour, according to the National Directory of Marriage & Family Counseling. Here’s good news: According to the American Association for Marriage and Family Therapy, “average costs for marriage and family counseling are typically 60 percent of that of psychiatrists and 80 percent of psychologists.”

Insurance Claims

“Insurance generally will not pay for marriage counseling unless the counselor finds you or your spouse (are) suffering from a mental disorder,” according to the NDMFC. If this is the case, you can make a claim for your marriage counseling sessions. While your marriage may improve, your future prospects could be damaged. A mental disorder diagnosis winds up on medical records for years and could prevent you from being hired in the future. Per the Patient Protection and Affordable Care Act, such a diagnosis wouldn't mean you could be prevented from being insured in the future, but if it’s rescinded and pre-existing conditions are fair game, you could be denied health insurance.

Medically Necessary

A bounty of research proves that “living in a distressed relationship makes one more susceptible to real illness, such as depression or heart disease,” the therapists say at the Collaborative Couples & Family Counseling agency in Washington. "Medically necessary" can be interpreted in ways that are legal and qualify a couple in treatment for insurance reimbursement. Procedure codes tracking diagnoses, treatments and timelines can be used to prove that marriage counseling is a medical necessity. If, for example, a spouse exhibits psychological and physiological symptoms that stress a marriage to the breaking point, a properly credentialed marriage counselor may be able to make a case for insurance reimbursement.

Taking the Risk

According to the CCFC, “A University of Illinois study revealed that half of the Fortune 500 corporations acknowledged using employee medical records in making employment decisions,” so it’s up to you to decide whether to risk being rejected for a job in the future based on your insurance claim. Federal and state privacy laws protect couples undergoing marriage counseling, which is why some practices insist that you pay your fees up front and seek reimbursement directly from the insurer. Additionally, if you claim your marriage counseling fees as a deduction, even if the insurer has accepted your claim, the Internal Revenue Service could reject the expense; so proceed with caution.