Couples Counseling and Insurance

Does insurance cover couples counseling? It depends. This page will answer frequently asked questions about insurance reimbursement for couples counseling.

Couples Counseling Associates is in-network with Blue Cross Blue Shield PPO. We provide complimentary billing for all other out-of-network insurance companies. Please note: Dr. Sara Schwarzbaum does not bill insurance.

For the service to be covered by Blue Cross Blue Shield PPO:

1. Our intake counselor will verify your benefits, deductibles, and copay.
2. Your counselor will bill your insurer directly. You are responsible for deductibles and co-pays. Please note that this is only a verification of benefits. All claims are subject to insurance review, eligibility requirements, and medical necessity. Unpaid claims are the client’s responsibility.
3. You may want to know how many sessions of counseling will be covered under your plan, per plan year.

Caution: Even though you may have BCBS PPO for medical coverage, some BCBS plans are contracting with third-party providers for their mental health coverage. Please double check.

Out-of-network coverage

If you pick a counselor who is not a provider in your network, and you would like to get some reimbursement, you can ask our intake counselor to verify your benefits. We offer complimentary billing for out of network insurance companies.

Your insurance company has the rate of reimbursement for utilizing an out-of-network provider under your outpatient mental health services benefits. Some of our clients have very good out-of-network provider benefits. You will pay us directly first at our rates.

Many companies reimburse 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. Reimbursement depends on your out-of-network benefits for outpatient mental health services.

We will bill your insurance company and you will get reimbursed. If you utilize our complimentary billing service, the reimbursement will go directly to you.

As an alternative, you can request that your counselor provide you with a bill or statement for the services. You can then submit the statement and a copy of your medical card to your insurance company for reimbursement. The company will reimburse you directly.

MSAs or FSAs

You can also use your Medical Service Account or the Flexible Spending Account debit card for your couples counseling services. Even though you won’t get reimbursed, your payment goes towards the total amount you selected for a given plan year.

Caution: If you are covered by an HMO plan, you may not get reimbursed for using an out of network provider. Be sure to check with your insurance provider.

Benefits

The most obvious benefit is that the out-of-pocket cost of counseling services is lower for the client.

Clients sometimes utilize services for a longer period of time, without worrying too much about out-of-pocket costs.

The CCA counselor bills the company directly and clients only pay the copay. Clients don’t have to deal with insurance bureaucracy, the counselor does.

You can read more about insurance here.

Drawbacks

• Patient privacy cannot be guaranteed
• One member of the couple will be issued a mental health diagnosis
• There is less flexibility. Insurance only pays for a 50-60 minute session. Sometimes couples benefit from longer, intensive sessions
• Many experienced couples counselors do not want to be associated with certain companies that have a very low rate of reimbursement

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

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 helping couples to improve their relationship. Not all counselors have the training and experience to help couples in distress.

Watch a one minute video below about what couples counseling and car maintenance have in common.