Insurance and Couples Therapy: An Inconvenient Truth

A Secret Not Discussed

The Truth About Couples Therapy and Insurance

Hello, Potential Client,

There’s an unfortunate reality about couples therapy that most people aren’t aware of: insurance companies do not cover couples therapy. Your therapist might tell you they do, and your insurance provider may say the same—but in most cases, they’re both misleading you.

Here’s Why

Insurance companies only cover mental health services they deem "medically necessary." This means that, in order for therapy to be covered, the person receiving treatment must be diagnosed with a mental illness.

That means whether you’re seeking therapy for job stress, the loss of a loved one, or just needing someone to talk to—if you're using insurance, then legally and for billing purposes, you are being treated for a mental illness.

For some individuals, this might not seem like a big deal. However, many clients have walked into therapy believing they were simply getting support, only to later realize they had been officially diagnosed with a serious mental illness—one that could follow them into their medical records, affect insurance policies, and, in some cases, even impact job opportunities requiring security clearance.

For individual therapy, this might be an unavoidable part of working within the system. But when it comes to couples therapy, it’s a different story entirely.

Why Insurance Doesn’t Cover Couples Therapy

If you’re working with a competent couples therapist, the focus isn’t on you or your partner as individuals—the focus is on your relationship. We work on communication, interaction patterns, and relational dynamics.

The problem? Insurance companies don’t consider relationships to be "medically necessary." There is no billing code for "relationship distress" or "poor communication patterns." So how do therapists get around this?

By diagnosing one partner with a mental illness and claiming the therapy is focused on treating their disorder—while secretly providing couples therapy under the guise of “family” therapy.

This Is Insurance Fraud

To make this work, therapists often write progress notes that reflect what the insurance company wants to see, rather than the reality of what’s happening in therapy. This way, they can get paid.

Now, let’s be real: in most cases, this works out fine for both the therapist and the client. But in some cases, it can be devastating—especially if that diagnosis ends up in a partner’s medical record or is later used in legal situations like divorce, custody battles, or even employment screenings.

The Ethical Alternative

A good therapist should be upfront about this reality. If you're seeking couples therapy, you deserve transparency about how it’s billed and what it means for you.

That’s why most ethical couples therapists do not take insurance. Instead, they offer private pay options, sliding scale rates, or structured packages designed to help you get the most out of therapy without unnecessary complications.

So, if you're looking for couples therapy, ask your therapist the hard questions:

• How do you bill insurance for couples therapy?

• Will I (or my partner) be given a mental health diagnosis?

• What are the potential long-term implications of that diagnosis?

  
  

If a therapist isn’t honest with you about these things, that’s a red flag.

If you’re considering couples therapy and want transparent, ethical support, I’d love to help. I offer a free consultation as well as have expert knowledge on a very specific relationship dynamic. This ensures that our work will be tailored to your problems. Reach out, and let’s talk about what’s best for you—without the hidden fine print.

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Ethical Couples Therapy