Couples Therapy Billing

Insurance covers treatment of illnesses, including mental illness like depression and anxiety. By definition, illnesses afflict one person at a time.  Insurance is often flexible about how a mental illness is treated, and if a family member/spouse needs to be involved and present in the treatment of the illness, they will usually cover that.  In this scenario, one person is diagnosed (the “primary client”), and the treatment file reflects ongoing treatment for that person’s diagnosis, and the notes reflect that a partner was present to support that treatment. This is usually the scenario insurance companies are referring to when they say they cover couples counseling.

More often, though, couples come to therapy to work on things like communication, conflict, navigating a transition, or rebuilding after a rupture. These challenges are generally not considered medical conditions that insurance covers. In these cases, the relationship itself is the focus of therapy, not one person's mental health diagnosis. Billing insurance as though couples sessions are treating a single individual's mental illness would be an inaccurate reflection of what is happening in therapy. Additionally, our couples therapists think of the relationship as the client, which means identifying one partner as "the patient" doesn't reflect how the work actually gets done, and can unfairly place the burden of the relationship's challenges on one person.

There's also a practical consideration: when only one person is designated as the client, the other partner has no rights to the records without a release from the identified client, which can create complications down the road.

For all of these reasons, we do not bill insurance or provide superbills for couples counseling at Riverbank Therapy. Our out of pocket session rates can be found here.