using insurance for couples therapy: what to ask and what to know
- 2 days ago
- 4 min read
The honest answer is: it depends-and the way you ask matters
If you've ever called your insurance company and asked 'Do you cover couples therapy?' you may have gotten a quick 'no' — and stopped there. That's an understandable response to give, and an understandable place to stop. But it's not always the full picture.
This post will help you understand whether using insurance for couples therapy is worth it before you assume coverage isn't available. This post explains why the answer is more nuanced than it might seem and gives you specific questions to ask that are more likely to yield useful information.
Why is using insurance for couples therapy not covered?
Health insurance is designed to cover the treatment of a diagnosable medical or mental health condition in an individual. Relationship concerns — conflict, communication, intimacy, disconnection — are not, on their own, a diagnosable condition under the frameworks insurance uses.
That's why many plans say they don't cover 'couples therapy' or 'marriage counseling' as a category. They're not wrong, technically. But that framing misses something important.
When couples therapy sessions may be covered by insurance
For insurance to potentially cover couples sessions, a few things need to be in place. One partner must be designated as the Identified Patient (IP) — the person with a documented mental health diagnosis whose care the sessions are connected to. The sessions must also meet the insurance standard of medical necessity, meaning they are clinically connected to treating that person’s diagnosed condition. Relational distress on its own is generally not enough to meet that bar.
If one partner is working through depression, anxiety, PTSD, or another condition that shows up in the context of close relationships, conjoint therapy may genuinely be part of their treatment plan.
Whether this applies to your situation depends on the clinical picture. It’s worth a conversation with the practice before you assume coverage doesn’t exist.
What to ask your insurance company
Try asking about coverage for the specific CPT billing codes used for conjoint therapy sessions. The two main ones to ask about are:
• 90847 — Family/conjoint psychotherapy with the patient present. This is the standard code for couples' sessions where both partners attend.
• 90846 — Family/conjoint psychotherapy without the patient present. Used when a therapist meets with one partner to discuss the Identified Patient’s care, without the IP in the room.
When you call member services, you might say: “I’d like to understand my outpatient mental health benefits. Can you tell me whether CPT codes 90847 and 90846 are covered under my plan?”
This question tends to get you real, actionable information about what your plan will actually reimburse — which is far more useful than a flat yes-or-no on couples therapy as a category.
Other things worth asking your insurance company
While you have them on the phone, it's also helpful to ask:
• Do I need a referral from a primary care provider before starting mental health services?
• Do I have a deductible? If so, has it been met for this plan year?
• What is my copay or coinsurance for outpatient mental health visits?
• Are there limits on the number of sessions covered per year?
• Is there a separate deductible for mental health versus medical services?
Write down the answers, and note the name of the representative you spoke with and the date. Insurance answers given verbally aren't always guaranteed — having a record is helpful if questions come up later.
self-pay (out-of-pocket) options
If your insurance doesn't cover the sessions, or if you prefer not to use insurance for privacy reasons, out-of-pocket payment is always an option. Rates vary by practice. Some practices offer sliding scale fees based on income — it's worth asking.
At MindBalance Mental Health Care, we can talk through your financial situation and help you understand your options before you commit to anything. We'd rather you have the full picture than feel like cost is a barrier you have to navigate alone.
a note on privacy and insurance
Using insurance for mental health services means your insurer will have some information about your care — the dates of service, the billing codes used, and the diagnosis on file. For some people, this is a non-issue. For others — particularly those in relationships where financial accounts are shared, or in professions where mental health records are scrutinized — it's worth knowing before you decide whether to use insurance. This is your decision to make with full information.
Also in the Couples Therapy in Minneapolis Series:
Ready to get started?
Our couples therapist brings specific training in relationship work, holds affirming values across all identities and relationship structures, and offers sessions in English and Spanish — in person in Minneapolis and online across Minnesota. If you’d like to learn more or get a sense of whether we might be a good fit for your relationship, you’re welcome to reach out.
We're a small team, so when you reach out, you're reaching real people who will take the time to address your inquiry.
About the Author
Merrily Young-Hye Sadlovsky (she/her/hers), MSW, LICSW, LCSW, is a therapist, clinical supervisor, and co-owner of MindBalance Mental Health Care, an independent holistic mental health practice serving Minneapolis and individuals across Minnesota. She is an EMDRIA EMDR-Certified Therapist and teaches clinical courses as an adjunct faculty member in an MSW program in Minneapolis. Her work focuses on culturally responsive, trauma-informed therapy supporting adoptees, BIPOC, immigrant, and LGBTQ+ communities, and college and graduate students navigating anxiety, OCD, trauma, disordered eating, and life transitions.
Educational Disclaimer
The information shared in this blog is for educational and informational purposes only and reflects our perspectives and understanding at the time of writing. It is not intended as medical, mental health, legal, or insurance advice, and should not be relied on as such. Reading this content does not create a therapeutic or professional relationship. For guidance specific to your situation, we encourage you to consult with a qualified professional.
