Does Insurance Cover Couples Counseling?

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Before we dig into the details, let’s address something important:
This article isn’t meant to defend the way the insurance system works.
In fact, most therapists—including those who accept insurance—don’t necessarily agree with how the system is structured.

We don’t make the rules. But like many other small healthcare providers, we follow them because for many clients, insurance is the only way therapy becomes financially accessible.

To put it plainly: We accept insurance not because we believe in the system, but because we know people deserve care—even within a broken one.

Here’s the harder truth: The insurance model is built to keep people from becoming miserable—not to help them truly thrive.

It’s designed to fund the bare minimum: symptom management, crisis containment, and short-term interventions. It was never designed to promote deep healing, relational growth, or long-term emotional wellness.

This means that navigating couples counseling through insurance can be confusing—because the system itself doesn’t fully recognize relational wellbeing as medically necessary.

Let’s break down how it actually works.

Why Can’t Insurance Just Cover Therapy for Two People?

Think about other types of insurance:

• Home insurance is tied to a specific property.
• Auto insurance is tied to a specific vehicle.
• Medical insurance is tied to a specific person with a diagnosis.

So when a therapist submits a claim, we’re not just telling the insurance company what service we provided—we’re also saying who received it, why, and how we’re treating it. This is done using a standard claim form called the CMS-1500, which all medical professionals use when billing insurance.

Here’s what that form looks like (you’ll notice there’s only room for one patient name):

How It Can Be Covered

In some cases, insurance will cover couples counseling, but only under the following conditions:

1. There is one identified patient.
   One person must come forward to be evaluated individually. This session will include questions about symptoms, mental health history, trauma, and functioning.
2. There is a diagnosis.
   If the therapist determines that the person meets criteria for a mental health condition (such as depression, anxiety, PTSD, etc.), a diagnosis is documented.
3. There is a treatment plan for that individual.
   The therapist creates a plan focused on helping that one individual. In some cases, the therapist may determine that couples counseling could help address that individual’s symptoms.

Important: The couple does not sign this plan—only the identified individual does, because they are the one receiving care from the insurance company’s perspective.

Why This Feels Confusing (And Sometimes Frustrating)

A lot of people have had therapy experiences where this wasn’t explained to them. Some have even believed they were getting “insurance-covered couples therapy” with no diagnosis or intake session. But here’s the truth:

• Every insurance company—Aetna, Blue Cross Blue Shield, UnitedHealthcare, etc.—requires a diagnosis.
• Every insurance claim uses the CMS-1500 form, which only allows for one patient to be billed.
• If a therapist bills for couples therapy without an identified patient and diagnosis, they are likely violating insurance policy or committing fraud.

In fact, clients who’ve switched to my practice from other clinics are often shocked to learn this—many say no one ever explained it to them.

What You Can Do

1. Check your benefits: Call your insurance and ask if your plan covers CPT code 90847 (that’s the code for family therapy with the patient present).
2. Ask the right question: Don’t just say “Does it cover couples counseling?” Instead, ask: “Does my plan cover CPT code 90847 when it’s medically necessary to treat a diagnosed condition?”
3. Get clarity from your therapist: A good therapist should clearly explain who the identified client is, what the diagnosis is, and how the treatment plan will    work.

A Final Note on Fairness

If this process seems unfair, you’re not alone. Many clients feel frustrated that their relationship issues don’t “count” for insurance purposes. You’re allowed to feel that way. If you believe you were misled in the past, or just want answers, you can:

• Call your insurance provider and ask about your past claims
• File a complaint with your state’s insurance commissioner
• Seek clarity from current or past providers

This issue exists nationwide—not just in Arizona—and every provider who bills insurance has to follow these same rules.

Don’t Let Insurance Be the Only Factor

Whether or not insurance covers your sessions, couples therapy can be life-changing. At our practice, we offer affordable private-pay options, including sliding scale spots and payment plans, because we believe relationship health is part of mental health.