Insurance vs Private Pay for Couples Therapy

How to Pay for Couples Therapy

Choosing to go to couples therapy is difficult. Figuring out how to pay for it is a challenge in itself. Here is some help to understand your options.

Private Pay – The Simple Way

Both Partners are Equal Clients

When you choose private pay for couples therapy, BOTH partners are considered clients and BOTH have client rights and access to records. Two big examples of client rights would be the right to access your portion of the records and the right to confidentiality (with exceptions as listed in the Notice of Privacy Practices and informed consent forms). Using the private pay option also means you don’t have to have a diagnosis. Our treatment can fully focus on your relationship dynamics without needing to identify one partner as having a clinical issue.

Real-Life Example: Joe and Megan Choose Private Pay

So, to give an example, if Joe and Megan came for couples therapy and decided to take the private pay route, both of their names would be on their file, they would both fill out client consent forms, and they would both have full client rights and access to their own records only, unless the other party signed a release for their portion of the records.

Insurance-Covered Couples Therapy – The More Complex Option

The “Identified Client” Approach

Now for the more complex, but potentially more available option. When going through insurance, one person is the “identified” client and one person is the “collateral contact.”

Why Insurance Needs a Diagnosis

In order for insurance to deem something coverable, they want to know if medical necessity is present. They usually do this through a diagnosis to determine if they can justify covering it. So when a couple comes to treatment and wants it to be covered under their insurance, the therapist will assess for any existing mental health diagnoses that may be present e.g. generalized anxiety disorder, major depressive disorder, etc. If there is no diagnosable condition, insurance WILL NOT cover the sessions and they don’t routinely pay for couples therapy.

How Records Work with Insurance

Since insurance requires a diagnosis, this is where the need for only one client comes in. One client is given a diagnosis and everything runs through that client including:

• Single-Client Documentation: Only one partner’s name appears on the chart

• Diagnosis Attached to One Person: The mental health diagnosis becomes part of one partner’s medical record

• Record Focus: All documentation (notes, treatment plans) is written through the lens of treating the identified client’s condition

The Role of the Collateral Contact

The non-identified partner is considered a “collateral contact”. They are technically not a client in the session, don’t have access to any of the records, since only the client does, and therefore do not have client rights of confidentiality. This doesn’t mean your therapist is going to completely ignore holding your information confidential, but what you say is controlled by the identified client. Because of your role as collateral in the session where a client is present, everything that happens in the session is covered under the umbrella of confidentiality. Where it really comes into play is records retrieval and whose confidentiality is protected.

Real-Life Example: Insurance Coverage

Let’s take our couple from above, Megan and Joe. Megan and Joe still want couples therapy, but this time they want to get coverage through their insurance. The therapist will assess one of them for any existing mental health conditions that may be present. Joe’s assessments come back with a slight nod towards Major Depressive Disorder, mild, so Joe would become the identified client. The file would be in his name, and Megan would complete a collateral contact consent form, basically saying she has no rights. Joe would receive a diagnosis and everything in insurance would bill through his name, as well as everything in treatment would slightly skew towards Joe and supporting that diagnosis. Joe would have all client rights and Megan would have no rights. In this event, if they divorce and both request records, only Joe will have access to those records. Megan signed a consent form recognizing she does not have client rights and therefore cannot access the records from the treatment.

Comparing Your Options

Key Considerations When Choosing

There are pros and cons to both ways of going about paying for treatment. With using insurance, you are obviously paying less money. One of you will also receive a diagnosis. With private pay, you both have equal participation and rights as clients as well as the option for treatment to be tailored to both of you. With insurance, treatment can revolve around the person who is holding the diagnosis.

Only you and your partner know what is best for your needs for therapy. Here is some of the information from this article listed below in a bullet point format as well as a table so you can more easily review to make your decision.