Couples Therapy and Insurance: The Challenge and Reason We Do Not Accept It

I know we are not the only website to speak about this, and I wanted to share my own personal experience and challenge with the issues of accepting insurance for doing couples therapy work.

It is a common question to ask, "Do you accept insurance?" when you are seeking couples therapy, and I do not blame you. I pay for insurance and want to use it when I can, AND I unfortunately do not have insurance that covers most of the medical and mental needs in my life--so when I say I get it, I really get it! The answer our team gives is, "No, we do not accept insurance nor are we paneled with any."

Here's why-- when your insurance company says they cover couples therapy, what they are really saying is that your therapist can bill for couples therapy if the following happen:

1. One of you is the identified patient, which means that partner will receive a diagnosis that is billable and will be what is being treated in your couples therapy sessions. For example, your wife receives a diagnosis for anxiety, and the couple's therapy work is around how to support your wife with her anxiety, increase communication dynamics that decrease anxiety symptoms, and more.

2. The treatment plan for your couple's work is focused on the diagnosis of your partner. Your therapist needs to ensure the sessions are focused on that treatment plan and diagnosis.

You may think, "What's the big deal? That makes sense." And here is why this is an issue--most couples who seek out couples therapy are not typically seeking out therapy to work on the diagnosis one partner has. Most of the time, couples are seeking therapy to work on their relationship, whether that be the communication challenges, conflict dynamics, planning for their future, etc. The work is more collaborative and focused on the relationship as a whole, instead of how one partner's diagnosis is impacting these areas.

In our practice, our identified client is the relationship. We are focused on how to develop, heal, and create the relationship you both need and desire, which is why we do not accept or bill insurance. As we create a treatment plan, it is with the focus on the relationship. What does it need to grow, change, shift, and heal? What is each partner's piece in the dynamic, and how will they each need to take accountability for growth in order to help support the relationship growth? What is the ideal relationship they want to create? I do explore how each partner's background, history, and diagnoses could be impacting the relationship, but it is with the focus on how to treat the relationship and not an identified patient in the partnership.

Insurance does not cover the relationship as the identified patient, which is why we do not accept it. There are many therapists that do bill insurance for couples therapy and will meet the requirements of billing insurance. The main question to ask yourself is, what is your purpose and intention with your couples therapy work? Here is a helpful breakdown:

Are You in Couples Therapy to Support Your Partner’s Diagnosis or Your Relationship?

Focus	You’re Likely Supporting Your Partner’s Diagnosis If…	You’re Likely Supporting Your Relationship If…
Main Goal	The goal is to help your partner manage symptoms or function better day-to-day.	The goal is to improve how you connect, communicate, and navigate challenges together.
Primary Focus in Sessions	Sessions center around understanding your partner’s diagnosis and how to accommodate their needs.	Sessions focus on how both partners contribute to patterns and dynamics in the relationship.
Therapist’s Role	The therapist helps educate the non-diagnosed partner about the condition and strategies for support.	The therapist helps both partners identify interaction cycles, repair trust, and build intimacy.
Typical Language Used	“How can I help them cope?” or “How can I support their triggers?”	“How can we work better together?” or “How can we understand each other’s needs?”
Responsibility Distribution	Most responsibility for change or adjustment seems to rest on one partner.	Responsibility for change is shared and mutual—both partners are active participants.
Emotional Focus	The emotions discussed often center on empathy, patience, and caregiving for the diagnosed partner.	The emotions discussed often center on connection, mutual understanding, and relationship satisfaction.
Outcome Desired	The non-diagnosed partner wants to better handle their partner’s symptoms or avoid conflict related to them.	Both partners want a deeper, more fulfilling, and resilient relationship overall.
Session Dynamics	It can feel like “one person is the patient” and the other is the helper.	Both people are seen as equals navigating challenges together.
Progress Markers	Success looks like symptom reduction or increased functioning for one partner.	Success looks like stronger communication, closeness, and teamwork for both.
Therapeutic Approach	The therapist may use psychoeducation, accommodations, and emotional regulation tools specific to the diagnosis.	The therapist may use relational models (like Gottman, EFT, or Imago) to rebuild connection and trust.

As well as some reflection questions to help you discern what type of couples therapy you are seeking:

• When I think about therapy, am I more focused on their well-being or our connection?

• Do I feel like I’m walking on eggshells to manage their symptoms, or working on our dynamic together?

• Do both of us feel seen, heard, and supported in therapy—or mostly one of us?

• If the diagnosis were no longer an issue, would we still need therapy for our relationship?

• Does the therapist help us grow as a couple, or primarily help me understand my partner’s condition?

I hope this can provide clarity on this common issue and help you understand why some practices accept insurance for couples therapy and why some do not.

If you are looking to heal and develop the relationship you desire, reach out for a free 20-minute consultation with our team today. Shoot us an email at admin@connectedcouplescounseling.com