What are legitimate ways to get marriage counseling covered?
Here are four totally legit ways to get the help you need:
1. Employee-Assistance Programs
Your employer’s Employee Assistance Program (EAP) may be the first place to check whether you can get marriage counseling covered as a benefit. Many EAP's cover a broader range of health care benefits than insurance plans alone. AnEmployee Assistance Program (EAP)is a voluntary, work-based program that offers free and confidential assessments, short-term counseling, referrals, and follow-up services to employees who have personal and/or work-related problems.
Best of all? While some EAP programs are kept in-house, others are contracted to outside mental health providers, so you may find yourself going into a private office, and not a company HR Department.
2. Collateral coverage
Simply put, a collateral is a helper. Parents go to "play therapy" to get guidance as to how to best handle the child, but it is billed under the child's diagnosis. The parent is only there as a "helper" or "interested party."
But if your partner is suffering from a severe disorder that is impacting your relationship, you can become a helper who learns more about the illness and how you can respond effectively to this disorder. It's an effective use of your insurance dollars, whether or not you are covered under your partner's health insurance plan. These sessions can be schedule with the both of you, or privately with you alone, and you'll still be covered under the patient's insurance.
HOW COLLATERAL COVERAGE IS DIFFERENT THAN 'MARRIAGE COUNSELING'
A collateral spouse is NOT the patient and is not the focus of treatment. Neither are your marital troubles as a stand-alone issue. Further, the collateral is under no obligation to pay for this treatment. But can it improve your marriage? Sure, it can.
If your husband has alcoholism, or your wife was hospitalized for depression, you may be asked to participate in treatment for a wide variety of reasons:
- to gain vital knowledge of the mental health condition
- to establish appropriate boundaries
- to learn how to respond to emotional outbursts, chronic irritability or delusions.
But in every one of these cases, the treatment is focused on your partner and how you can assist them in healing.
3. Find university clinics or public health clinics that work under grants
There are many excellent university and training clinics that offer free or low-cost marriage counseling. Many have been givenblock grantsor grants from theNational Institute of Mental Healthto support the community and have greater flexibility in providing couples with longer and more frequent sessions than private practice providers can.
Just because these services are low cost or free, doesn't mean you have to accept whatever you're offered. Make sure that the therapist you see is fully trained as a couples therapist (not just has a degree in Marriage and Family Therapy) and has received or is currently receiving supervision from an experienced couples therapist.
These research departments may be conducting ongoing studies as to how to better help spouses where one or both partners are suffering from serious mental disorders such as mood disorders (depression, bipolar disorder, dysthymic disorder), thought disorders (such as schizophrenia or schizoid disorder), or anxiety disorders (such as generalized anxiety, agoraphobia, or social phobias.)
Taking part in these types of services not only provides you with the most innovative treatment available, but also helps further the entire field of mental health.
The University of Minnesota, for example was instrumental in developingDiscernment Counselingwith faculty member Dr. Bill Doherty. Those lucky couples who sought low or no cost treatment received innovative services from an internationally recognized expert.
Contact your local university or mental health clinic and ask if they have ongoing research projects or train graduate interns in couples therapy. While an intern may have less years of clinical experience, they may also have had the most up-to-date clinical training. In addition, they are supervised by more senior, experienced, staff members.
4. Receive treatment for a sexual dysfunction when covered by your plan.
While it is possible to receive individual treatment forsexual health problems, conjoint treatment (the two of you seen together) is a perfectly legitimate way to have your couples therapy covered. Be certain that your therapist has the qualifications to practice as a sex therapist. It may be necessary and preferable for couples therapy to be an integral part of the clinical work done on helping one or both of you with your sexual problems. But be sure treatment of sexual disordered is covered by your plan. Many do not, even though it's not a Z-code and is listed as a diagnosable mental disorder.
Three unlikely ways health insurance covers marriage counseling:
1. ACA Health Insurance
While the Affordable Care Act (ACA) considers mental health to be an “essential benefit” for individuals, marriage counseling isn't covered because it is not a treatment for mental illness.Collateral coverageis often the exception.
2. COBRA
Cobra is an extension of your employer coverage. If this coverage included payments for Z-codes (Z-63.00: relationship problems), you would continue to receive this reimbursem*nt. If it didn't cover Z-codes while you were working, it's not likely to do so now. Read your policy carefully.
3. Medicare
Medicare Part B covers collateral family counseling. In other words, if you are a"collateral"there to offer support, gain knowledge about your spouse's condition (such as dementia), and how to adapt to it more effectively, your spouse's Medicare coverage will kick in.
But this is no small thing. The slow and insidious onset of dementia disorders like Alzheimer's Disease requires couples to work together early in the disease progression. It allows both to plan for the inevitable decline of cognitive and self-care function, so your spouse isn't left on their own. Also, don't forsake your own need for individual therapy during this time. It's an appropriate use of health insurance funds.
Medicare does not cover marriage and family therapists (MFT's) unless a clinical facility, hospital, or other Medicare eligible agencies employs them.
When does health insurance cover marriage counseling?
Covering Z-code
Zcodes are a special group of codes used for reporting issues that impact health status (like a troubled marriage) but are not considered a mental illness. There are some insurance providers who will cover Z-codes, often for a limited number of sessions (typically 8-10 sessions.)
About the 45-50-minute session and marriage counseling
Please note however, that this is coverage for 50-minutes, and not evidence-based 80-90 minute sessions.
Fifty-minute sessions are enough time for you to get into a fight with your partner, but not enough time to resolve them. They typically result in long, silent car-rides home and continued fighting or stony silences once you get there. Then, two weeks later, you go back for another 50-minute session and repeat the same pattern.
Most couples quit after 4 of these "marriage counseling" sessions, believing it is theirmarriage, and notthe inadequate care, that is responsible for this "failure in couples therapy."
If health insurance covers relationship counseling, it willdo so because all Z-codes are covered by your health insurance plan.
A Z-code accurately describes marriage counseling but, few providers use it when seeking reimbursem*nt. As I've already explained, it is because they are well aware that most health insurance companies do not reimburse for relationship problems. They’d rather not risk wasting their time and the client’s time submitting a claim when it is most likely to get rejected by your insurance company.
Aa Dan Stober, a therapist from Tennessee says:
"Your health insurance is like that. The benefits may be limited to treatment that are considered a “medical necessity.” My health insurance will pay for my appendectomy, but not my face lift (or my marriage counseling)."
