When the primary reason for seeking therapy is a relational or relationship problem, such as communication difficulties, ongoing conflict, trust issues, or other concerns within the relationship, like navigating ENM, we do not bill sessions to insurance.
The reason for this is that insurance generally requires services to be provided for the diagnosis and treatment of a covered mental health condition and to meet the insurance company's medical-necessity criteria. When the primary presenting concern is the relationship itself, couples counseling does not meet those requirements. If submitted to insurance, there is a significant possibility that the claim could be denied or rejected.
A denied claim can create financial uncertainty for both of us. In particular, an insurance denial could result in payment being denied to the provider while potentially leaving you responsible for unexpected costs that were not anticipated when treatment began. To avoid putting you in that situation, we will not submit couples counseling sessions to insurance when the relationship concern is the primary reason for treatment.
For couples counseling in these circumstances, sessions would therefore be provided on a private-pay basis, with the fee discussed and agreed upon before treatment begins. This approach allows us to be transparent about the cost of services and avoids relying on an insurance benefit that may not apply.
