Is Couples Therapy Covered by Insurance? Anthem, Out-of-Network Benefits and What to Ask

Sometimes. In Connecticut, as elsewhere, insurance usually pays for couples therapy when the sessions are part of treating a diagnosed mental health condition in one partner, such as depression or anxiety. Sessions whose only goal is to improve the relationship are often not covered. The only way to know for sure is to ask your plan the right questions, which are listed below.

I am not in-network with any insurance plans, and couples often ask me how their coverage works before we start. Here is what I tell them.

Why does insurance treat couples therapy differently?

Health insurance pays for the treatment of a health condition. Couples sessions are commonly billed as family psychotherapy, a service tied to one person's diagnosis. One Medicare contractor's coverage policy shows how insurers commonly think about this: "Family psychotherapy must be ordered by a provider as an integral part of an active treatment plan for which it is directly related to the patient's identified condition/diagnosis" (Centers for Medicare & Medicaid Services, 2020).

In practice, that means a couples session can be covered when one partner has a diagnosis and working together as a couple is part of treating it. When the goal is only better communication or a stronger marriage, many plans will not pay.

Does Anthem cover couples therapy?

Anthem's individual and family plans include mental health care, and Anthem states that the Affordable Care Act "requires that all individual and family plans sold through the Health Insurance Marketplace include mental healthcare," including "in-person or virtual psychotherapy and counseling" (Anthem, n.d.).

Anthem does not publish one rule for couples therapy across all of its plans. Whether couples sessions are covered depends on your specific plan and on whether the sessions are part of treating a diagnosis. That is why it is worth calling before your first appointment.

Does mental health parity mean my plan has to cover it?

Not exactly. The federal parity law means that when a plan covers mental health care, it cannot make that care harder to use than medical care. Copays, coinsurance and visit limits for mental health "cannot be more restrictive" than those for most medical benefits. The same law, however, "does NOT require group health plans or health insurance issuers to cover MH/SUD benefits" (Centers for Medicare & Medicaid Services, 2026). Parity is about fairness in what your plan does cover. It does not add couples therapy to a plan that excludes it.

What should I ask my insurance company?

Call the member services number on your insurance card and ask:

• Is outpatient mental health care covered on my plan, and is there a deductible, copay or coinsurance?
• Is family psychotherapy covered? Couples sessions are commonly billed as family psychotherapy, which uses the codes 90847 (when the partner being treated is in the session) and 90846 (when they are not) (Iowa HHS, 2023).
• Does coverage require a diagnosis for one of us?
• Is my therapist in network? If not, do I have out-of-network benefits, and how do I submit a claim?
• Is there a limit on the number of sessions per year?

What if my plan does not cover couples therapy?

You still have options. If you have out-of-network benefits, you can pay for the session and submit a claim for reimbursement. Anthem notes that when you see a provider outside your plan, "you may have to do this yourself," and that the claim form needs "procedure codes (you can receive these from your doctor's office)" (Anthem, n.d.).

While I am not in-network with any insurance plans, I will work with you to determine your out-of-network benefits and provide you with all the necessary paperwork to submit to your insurance company for reimbursement or use for your FSA/HSA account. If you are not using insurance, you have the right to a Good Faith Estimate of your costs.

How much does couples therapy cost with me?

Please contact me to discuss fees, insurance, and payment options. I accept cash, credit card, Venmo or check at the time of service. You can read the details, including my 24 hour cancellation policy, on my Starting page.

Couples therapy in Greenwich, CT and virtually across CT and NY

If you are thinking about couples therapy, a phone call is the easiest place to start. I see couples in person in Cos Cob and virtually anywhere in Connecticut and New York. I offer a free phone consultation, so you can get a sense of whether we have a good match, and we can talk through your coverage together. You can read more about my couples therapy and marriage counseling in Cos Cob, or call me at 203-660-0613.

References

• Anthem. (n.d.). Understanding mental health coverage in the U.S. https://www.anthem.com/individual-and-family/insurance-basics/health-insurance/mental-health-aca-plans
• Anthem. (n.d.). What to know about Anthem claims. https://www.anthem.com/member-resources/claims
• Centers for Medicare & Medicaid Services. (2020). Local coverage determination L33252: Psychiatric diagnostic evaluation and psychotherapy services (First Coast Service Options; applies in Florida, Puerto Rico and the U.S. Virgin Islands). https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?lcdid=33252
• Centers for Medicare & Medicaid Services. (2026). The Mental Health Parity and Addiction Equity Act (MHPAEA). https://www.cms.gov/marketplace/private-health-insurance/mental-health-parity-addiction-equity
• Iowa Department of Health and Human Services. (2023). Functional family therapy (THR-003), Iowa Medicaid program criteria. https://hhs.iowa.gov/media/10632/download