insurance won’t cover your couples therapy
If you’ve ever tried to use your insurance for couples therapy, you may have experienced the joy of being told “We cover that!”—only to find out later that, actually, they don’t.
It’s not you. It’s not your therapist. It’s the rules. And those rules make about as much sense as arguing over where to eat when you’re both hangry.
The Strange World of “Medical Necessity”
Insurance companies live by one mantra: We only pay for things that are “medically necessary.”
Sounds reasonable, right? Except in practice, that means:
One of you must be declared the identified patient.
That person has to have a diagnosable mental health condition.
Every single session note has to prove that what we’re doing is treating that condition.
So if you’re here to work on trust, communication, or things heating up (or cooling down) in the bedroom—well, unless we can directly link that to one partner’s diagnosis, the insurance company won’t pay. Which means your “romantic getaway” to therapy island just hit customs without a passport.
But My Friend Said Their Therapist Billed for Couples Therapy…
Yes, sometimes people have had insurance cover couples sessions. This usually happens because:
The therapist wasn’t aware of all the fine print (and let’s be honest—insurance rules read like the warranty booklet for a spaceship).
The therapist took a calculated risk and billed it under one partner’s diagnosis.
The problem? Insurance companies do audits. And when they do, if the sessions didn’t meet the rules, they can demand the practice pay the money back. That’s why many therapists don’t take that gamble—it’s like playing poker with someone who can change the rules after the hand is over.
The “Family Therapy” Trap
Insurance companies add to the confusion by saying, “We cover family therapy!” And they do… but only if it meets the same medical necessity rules. They just forget to mention that part, which is like saying you can have unlimited breadsticks, but only if you already ordered the most expensive thing on the menu.
So What If I Still Want to Use Insurance?
Here’s the best route: start with an individual session.
We’ll see if your situation meets the medical necessity criteria, and if so, we can invite your partner in later. But know this:
One of you will get a diagnosis (congrats?).
All notes will tie back to that diagnosis.
Your partner’s involvement will be framed as part of your treatment, not as equal relationship therapy.
Bottom line:
It’s not that your therapist doesn’t think your relationship is important. It’s that insurance rules were designed for illnesses, not for helping two people figure out why they keep fighting about dishes. If you want therapy where your relationship is the client, paying out of pocket is usually the most honest, drama-free way to go.