Couples Therapy Disclosure

Before scheduling an initial couples therapy session, Evergreen Pathways requires therapists to hold a brief, 15 minute consultation with both partners.

During your brief consultation, the therapist will get to know both partners, learn about what brings you both to therapy, discuss your goals, and determine if you are a good fit to work together. They will also gather data to determine whether either of you is experiencing mental health symptoms that may be contributing to the relationship difficulties. This will help the therapist determine if couples therapy is medically necessary, which is a requirement for insurance companies to pay for couples therapy. If couples therapy is not medically necessary, the therapist may determine that couples therapy cannot be billed to your insurance, meaning you will need to utilize a private self-pay option to pay for couples therapy.

How insurance works in general: 

In order to pay for any individual’s treatment, insurance companies require that treatment be medically necessary to improve the individual’s symptoms and level of function related to a diagnosable mental health condition. When we bill an individual’s insurance, health insurance companies require that for each date of service, the clinical documentation includes a diagnosed mental health condition for the individual receiving services, details about their symptoms and daily functioning, current treatment goals and objectives aimed at improving symptoms and daily function, and ongoing monitoring of therapeutic progress to support ongoing medical necessity of the therapy. 

How insurance works for couple therapy:

In the case of working with couples, insurance companies will only pay for the treatment (couples therapy) if it is directed toward treating one partner’s (referred to as the identified patient) mental health condition in order to improve that individual’s symptoms and daily functioning. This means that in order for Evergreen Pathways to bill your insurance company for couples therapy, your therapist will need to identify one of you as the patient having a diagnosable mental health condition with reported symptoms and decreased level of function. We cannot identify both of you. The treatment (or couples therapy), would then also need to satisfy the insurance company’s medical necessity requirements for any individual as described above, meaning, after each session the therapist must focus their clinical documentation on treating the identified patient’s mental health condition.

How does Evergreen Pathways approach couples therapy?

Insurance-based couples therapy: When we bill insurance for couples therapy, we are able to do this because we have identified one partner in the relationship as the patient having a diagnosable mental health condition that is affected by the relationship dynamics. In these cases, to ethically meet insurance requirements, we must tailor the couple therapy and treatment plan toward improving the identified patient’s symptoms and level of function rather than improving the relationship. When we bill insurance for couples therapy, both parties may attend the couples therapy sessions. However, in order for those sessions to be covered by insurance, the non-identified patient’s involvement must only be to support the identified patient's goals. Meaning, if the treatment is tailored toward both parties' equal contributions to the relationship challenges, insurance companies will not pay for couples therapy services. 

Self-pay couples therapy: When we focus primarily on improving the relationship, such as strengthening communication, resolving conflict, rebuilding trust, or increasing emotional connection, we are focusing on both parties’ equal contributions to the relationship, not one identified patient’s diagnosable condition. Consequently, absent a diagnosable mental health condition, insurance companies will not pay for your couples therapy. Our self-pay rate for couples therapy is $150 per session and we do not provide superbills because ethically, we are not treating a diagnosable mental health condition.

Let’s connect!

Please contact the therapist you are working with to schedule your free 15 minute consultation, we look forward to working with you.