Couples therapy, or relationship counseling, is a common approach for partners seeking to improve communication and resolve conflicts. Using health insurance for this service is complex because the billing structure differs fundamentally from individual medical care. Health insurance plans are designed to cover services that treat a documented medical or mental health condition, which a relationship itself is not. Therefore, the question of whether both people need insurance is determined by insurance company requirements, not the couple’s relationship status.
The Requirement for an Identified Patient
Health insurance policies covering mental health benefits require a medical necessity supported by a billable diagnosis. Since relationship distress is not classified as a mental disorder, the insurance system does not recognize “the couple” as the patient. To secure coverage, the therapist must designate one partner as the “Identified Patient” (IP), who receives the formal diagnosis. This diagnosis must be an ICD-10 code representing a covered mental health condition, such as an Adjustment Disorder, which is necessary for the claim to be processed.
The therapist’s documentation must frame the couples therapy as a necessary part of the IP’s treatment plan. Joint sessions aim to stabilize or improve the IP’s diagnosed condition by addressing relational factors contributing to their symptoms. Only the IP’s insurance plan is relevant because coverage hinges entirely on the IP’s diagnosed need. The other partner’s presence is considered a therapeutic component in the IP’s treatment, not a separately billable service.
How Billing Works When Coverage is Used
Once an Identified Patient is established, billing is streamlined through a single individual’s insurance plan. The therapist typically uses the Current Procedural Terminology (CPT) code 90847, designated for “Family psychotherapy (conjoint psychotherapy) (with patient present).” This code signals to the insurer that the session involved multiple people but focused on treating the single IP’s diagnosed condition. The claim submitted is filed exclusively under the name and policy number of the Identified Patient.
Since the service is considered one session tied to one patient’s medical necessity, the other partner does not need their own insurance for the session to be covered by the IP’s plan. A single service cannot be billed to multiple insurers; attempting to bill both partners’ plans for the same session would be considered insurance fraud. If the IP exhausts their covered benefits, the couple cannot switch to using the other partner’s insurance unless that second person is diagnosed and established as a new IP with a separate treatment plan.
Navigating Different Insurance Plans
The process remains consistent even when partners have distinct insurance situations, such as different carriers or plan types. Because the claim is submitted solely under the Identified Patient’s policy, the non-IP’s insurance details are irrelevant to coverage determination. For instance, if the IP has a PPO plan and the non-IP has an HMO plan, the therapist’s network status is only checked against the IP’s PPO network.
Whether the non-IP partner is uninsured or has a different insurer does not affect the claim’s processing. The service is considered medically necessary for the IP, and the other partner participates as a supportive figure in the treatment. The complex process of Coordination of Benefits (COB) is generally not applicable here, since only one person is officially the patient receiving the single service.
Payment Options Outside of Insurance
For couples who prefer to avoid the complexities of insurance billing or the requirement of a formal diagnosis, several alternatives exist. Self-pay, or private pay, allows the couple to pay the therapist directly for the services rendered. This option provides greater privacy because no diagnosis or treatment notes are submitted to an insurance company. Therapy can then focus purely on relationship dynamics without needing to justify medical necessity.
Many therapists offer sliding scale fees, adjusting the cost of a session based on the couple’s income and financial need, making private care more accessible. Additionally, funds saved in a Health Savings Account (HSA) or a Flexible Spending Account (FSA) can often be used for therapy payments. While these accounts offer a tax-advantaged way to pay, couples counseling must still be tied to a diagnosed mental health condition to be an eligible expense, similar to standard insurance coverage.