Question by Armored Polar Bear: How do therapists bill insurance companies for couples counseling?
My boyfriend and I have been together for 8 years. We are interested in going to couples counseling in order to work on any issues we have before moving forward. We both have health insurance but with two separate insurance companies. Do therapists typically bill both insurances (meaning we need to find someone that accepts both)? Is the therapy billed differently because its more than one person being serviced, meaning that couples therapy has to be specifically covered by our insurance companies? Any information would be great, thanks!

Best answer:

Answer by Josh
Well, insurance companies may or may not pay for this type of service so you might want to check with the insurance company beforehand (or have your provider verify benefits for you). Many require prior authorization – the insurance companies typically want documentation regarding the nature and necessity of these service before approving them. Benefits payable will be determined based upon how your provider bills the claim(s) to the insurer but they shouldn’t need to bill both your insurance companies for the service. They could bill one or the other and just report the code for “family therapy”. Essentially, the therapist would be billing for one of you as the patient and telling the insurance company that the patient’s family was present during the session. Knowing that, you’d probably want to use the insurance with the most generous coverage for this type of service.

Now, while I’m a health insurance claims analyst and have been for years, I will admit that mental health has become a rather specialized benefit area. These types of benefits are nowadays handled more and more by insurance companies/subsidiaries of insurance companies devoted specifically to behavioral health and this area isn’t my forte. I figured I would give you my thinking since I saw that nobody else had yet answered. Hopefully, someone with more specific experience in mental health benefits might answer as well 😉

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