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Couples Counseling and Insurance


Couples Counseling and Insurance

This page will answer some questions you may have about insurance reimbursement for couples counseling.

Below you will find instructions on how to request reimbursement if you use someone outside of your network , and also instructions on what to do if you decide to use a counselor who is in your network.

Don’t be surprised if you find that couples counseling for Prepare Enrich are not on the list of providers.

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Many counselors have decided to leave the medical provider panels (for many reasons) and have a strictly self-pay practice.

Those professionals accept payment directly from their clients, like any other service provider specialist.

You can, however, get reimbursement under your out of network provider benefits if your couples counselor does not bill insurance.

Think of couples counseling as a service in the same way that you think of any other professional service: You want to find a provider that specializes in working with couples in crisis, and in general, you get what you pay for.

Expert counseling focused on couples issues may cost more, but will provide you with freedom from medical diagnosis and flexibility of formats.

If you choose a provider who is not in your network

If you pick a counselor who is not a provider in your network, and you would like to get some reimbursement, you can

1) Ask your insurance company for the rate of reimbursement for utilizing an out of network provider of services under your outpatient mental health services benefits.

2) Request that your counselor provide you with a bill or statement for the services and submit to your insurance with a copy of your medical card.

In order for health insurance to cover couples counseling, companies require that one of the members of the couple be listed with a mental health diagnosis. They also require a service code.

Many companies pay well for their out of network provider services. They may not reimburse you for the entire amount, but you may be able to get a substantial portion back, depending on your out of network benefits for outpatient mental health services.

You could also use your Medical Service Account or the Flexible Spending Account for your couples counseling services.

You will not be reimbursed, but at least you can use the payment to your couples counselor toward the total amount you selected for a given plan year.

If you choose a couples counselor who is in your network

Don’t be afraid to make a phone call and ask questions regarding the experience and training of the counselor. Many counselors who are in provider panels do have experience and training helping couples.

For the service to be covered

1) You will need to discuss with your couples therapist which of the members of the couple will receive the mental health diagnosis. One of the two partners will need to have a diagnosis in order for your company to cover the services.

2) The counselor will bill your insurer directly, just like other providers do, for the services. You will be responsible for deductibles and co-pays.

3) You many want to know how many sessions of counseling will be covered under your plan, per plan year.


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