Can I Accept Insurance for Individual Clients But Not Couples?

Many therapists who’ve contacted me for a consultation want to know the answer to this question. These are compassionate, terrific therapists. They want to make therapy more affordable for their clients, so want to continue accepting insurance. So, why refuse to take insurance for couples?

For many, it is because they do extended sessions with couples, and — since Prolonged Services codes were deleted in January — even for a 90-minute or two-hour session couples session, the insurance plan will only reimburse what they would for a 50-minute session.

For others, it is the fact that the amount reimbursed for a couples session may actually be less than for a 60-minute individual session. This may seem to defy logic, since couples therapy can be more complex and require so much additional case management. I think couples should be covered at twice the individual rate!

Still others feel that it is a question of principles. They don’t feel what they are doing in couples is addressing a diagnosis or an identified patient, and don’t like that idea at all.

So, many couples therapists advertise on their websites or verbally tell all new clients that they don’t accept insurance for couples work. But is this OK?

It’s a juicy topic, right? I’ve discussed it with many attorneys and debated it with many therapists over the years. And I TOTALLY understand why you might not want to accept a couple’s insurance, for all the GREAT and rational reasons listed above. And I know I will hear a lot of passionate responses from my readers who will disagree with my viewpoint on this subject.

But here’s my take: I think it could be considered a violation of your insurance plan contract to refuse to offer couples therapy to a plan member. If your contract and their plan covers the couples therapy code (90847), then I believe you are both ethically and contractually obligated to provide this service when two conditions are met:

But please notice: these are the same conditions that must be present to bill insurance for individual therapy, and you probably don’t tell people up front you can’t bill insurance for that, right?

So my message is this: To avoid a contract violation, I don’t think we can make a blanket refusal of benefits before seeing the couple. I believe we need to access the clients involved to see if these two conditions apply, just as we do with individual therapy. If the two conditions outlined above are present, I feel we are obligated to follow the contract we signed, and to provide their care and bill their insurance — just as we must with individual treatment.

Another thought: While a couple might agree to pay out-of-pocket for sessions, down the line they could complain to the insurance plan, who could come down on you for violating the contract.

A final word: Consider, “what would you want if you were the client?” I know that if I was the client in distress, I would hope that a therapist — who is part of my insurance network — would allow me to use my coverage when appropriate for the treatment I needed.  I have paid throughout the year through costly insurance premiums to have my care covered when I need it.

Wanna hear more about this and other thorny couples therapy billing dilemmas and ethics?  Join me on Saturday, June 24th when I’ll be presenting “Couples Therapy: Billing, Documentation, and Ethical Dilemmas” or register and get the recording — click here for more info.