Using Your Insurance For Payment Of Couple and Marriage Therapy
Can be a Complicated Situation...
A point of awareness---your insurance carrier usually will Not reimburse or pay for couple or marriage counseling. The couple counseling procedure code is very different from individual and family codes, which require an individual diagnosis. The Couple, Marriage and Relationship Counseling code is called a V-Code (V61.10) and usually does not meet the criteria for insurance payment.
Insurance representatives will provide general mental health benefit information that is geared toward individual therapy and may interpret the couple or marriage therapy to be family therapy. Sometimes, the representatives might say that you have coverage, to later find out that you are not covered for couple specific therapy.
Most insurance companies require medical necessity in order to authorize mental health visits. The member or dependent member must have a mental health disorder with a diagnosis. In couple or marriage therapy, the patient is the couple unit and medical diagnosis is not used. However, if a member, in the couple unit, has a diagnosable mental health condition and has family therapy benefits, the insurance carrier will approve the therapy.
When you contact your insurance company about coverage and benefits it would be important to ask if they cover Partner Relational Problems V-Code V61.10. It will be the only code allowed to be used for Marriage, Couple, Relationship Counseling.
Another Option: If your employer participates in the Employee Assistance Program (EAP), you can contact your EAP for couple or marriage therapy authorization. Usually, EAP benefits consist of 2 to 12 visits, which provides an opportunity to begin couple/marriage therapy.
If you would like to further discuss insurance or payment for couple counseling or make an appointment, please feel free to contact me at the telephone number below:
Shirley Court González, LCSW, BCD
New Jersey: 470 Prospect Avenue, West Orange, NJ 07052
New York City: 412 Sixth Avenue, New York, NY 10011