Marriage Counseling and Insurance Options

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1 Marriage Counseling and Insurance Options Taking that first step to get help for your marriage can sometimes feel overwhelming. Managing the maze of insurance is usually the first hurdle to overcome. My goal is to provide a road map for finding your way back to a loving marriage and to make the initial process as easy as possible. It starts with that first phone call and questions you may have about your insurance coverage. Be a Savvy Consumer of Behavioral Health Benefits It is important to me that my clients make educated and informed decisions about this process. Finding out what is covered in your plan can be confusing. Even after verifying benefits over the phone, clients can receive an unexpected bill in the future because the representative didn t provide accurate information. Most insurance companies do not cover Marriage Counseling. Here s why. Insurance companies require a mental health diagnosis in order to process a claim. This is appropriate when an individual comes in for treatment and is dealing with significant mental health issues. A mental health diagnosis, which many people do not want on their permanent record, is not appropriate for marriage counseling because it would require the therapist to

2 randomly assign a mental health diagnosis to the spouse of his or her choice. Marriage Counseling involves working with the couple as a team to help them improve their marriage. Neither spouse should be assigned a mental health diagnosis in order to claim insurance benefits. It is important that you check with your insurance company to see if they cover Marriage Counseling. As I mentioned previously, the representative does not always give accurate information. That is why they provide you with their disclaimer: These benefits may be limited to treatment that is considered a medical necessity. A quote of benefits or authorization does not guarantee payment or verify eligibility. Payment of benefits are subject to all terms, conditions, limitations, and exclusions of the member s contract at time of service. Oftentimes the representative on the phone confuses Marriage Counseling with Family Therapy, but they are not the same. Family Therapy Sessions are used when a family member participates in a session or several sessions to help the Identified Patient work through his or her issues. The Identified Patient is the client that I am seeing who has the appropriate mental health diagnosis. These sessions are most often covered by insurance.

3 Marriage Counseling is usually not covered because there is no identified patient involved. The couple comes in as a unit, equally participating in treatment. When you call your insurance company ask them: Do you pay for the Diagnostic Codes V-61.1? (ICD Codes and DSM-5 Code: V61.1 Counseling for marital and partner problems) Make them look it up. Don t settle for some general answer like We pay for all the codes. Ask specifically for code V61.1. This way you will know exactly which services they will cover and you won t get stuck with a bill later on because of misinformation. Benefits and Limitations There are benefits to using your insurance if the service is covered, but there are limitations as well. I am often frustrated with the time constraints that some insurance companies put on the services I provide. Some will not permit me to spend more that 45 minutes in a session. Others limit the number of sessions I am permitted to offer. This may work for my individual sessions, but does not afford me the time necessary for my work with couples. Due to the issues mentioned above and after much consideration, I have decided that I will not be accepting insurance for my marriage counseling beginning January 1, 2015.

4 No matter which therapist you choose make sure you do your research so that complicated insurance issues don t add to an already stressful situation. With that said, my goal is to provide excellent service to my clients while making it affordable. There are two options available for couples. Please circle the option that best serves your needs. Option One You can choose to attend Couples Sessions at the regular rate of $125 per session. Option Two Receive significant savings and sign up for my Couples Program, which consists of: A Couples Session to assess issues of concern and to develop specific goals and objectives. A Session for each spouse to get his/her unique perspective of the situation. A 4 -Week Workshop held on 4 consecutive Wednesday evenings at my office from 6:30-8:30 pm.

5 Once you sign up for the workshop on my Website, the Couples Sessions are reduced to $95 per session. I will also include 4 post workshop sessions for the same price if you need them. I m aware that my insurance company does not cover marriage counseling. I m aware that my insurance company does cover marriage counseling. If your insurance company does cover Marriage Counseling and you wish to use your insurance plan, I can provide you with names of several competent Marriage Counselors in the area. If you still wish to pursue counseling with me and do not wish to use your insurance plan, signing this document will indicate that you have freely chosen not to use your insurance to cover this service. Signature Date Spouse Signature Date