Insurance
Insurance will sometimes not cover marriage counseling or couples counseling sessions because relationship issues are not considered medical problems or medical necessities. Instead, the insurance model is based on a diagnosed mental health condition(s) of one client, and specific treatment for those same conditions. Some providers list a mental health diagnosis and treat that with the couple (focusing on the primary client, as only one person can be named the primary client for insurance), but that puts your insurance company somewhat in charge of your care and may not allow a proper focus on the relationship (and you may not have a mental illness). This is a gray area, and different agencies understandably have different interpretations. Our interpretation is the way we counsel by focusing on the relationship as a whole as the client, does not match the insurance model. Using the Gottman method and others employ many techniques that are not specific to a mental health condition or only one person. Some providers may focus only on how your relationship impacts your condition as the primary client and only focus on the primary client’s goals. Other providers may only ask intake questions about the person who will be listed as insured. Insurance may very well cover what you are looking for and make sense. Still, it could be helpful to ask the provider in advance what it means to be covered by insurance during relationship counseling and how using insurance could impact your treatment (as well as asking your insurance company). Other providers believe as long as what they do helps address a diagnosed condition in some way, any treatment plan is fine. There is no judgment here as to what approach is “right”, but we have chosen to be self-pay as we believe that is the only ethical option for true couples therapy. We also believe in providing a significantly higher standard of care than what is required by insurance. We can give you a superbill for submission for out-of-network consideration, but we do not fudge diagnoses or records to make it look like the primary condition treated was anything other than the relationship if the relationship was the primary item treated.
The benefits of using insurance for mental healthcare are not as straightforward as they once were. In some instances, deductibles and co-pays are so high that paying with an HSA, FSA, credit card, debit card, or cash is more cost-effective. For example, some plans have a $4-6k deductible for mental health care. Some other considerations include whether you have a mental health diagnosis to be treated while treating your relationship (typically required), whether your insurance provider limits the number of sessions, and if you need a referral from a primary care physician.
There is also the matter of privacy and who is in control of your healthcare decisions. Insurance companies often want to control treatment options and the length of your treatment. It is in the best interest of insurance companies for clients to exit counseling quickly, but that may not be in the client’s best interest. A diagnosis could stick with you forever and impact life insurance approval, cost, or acceptance to medical school or the military. Paying in cash does not require a diagnosis on your record and would only be noted if you request it. Dealing with insurance is also time-consuming and takes our time away from helping you. We have more time to devote to you when we don’t have to spend half of our day dealing with insurance companies.
For the reasons above and others, Cardinal Point Counseling has decided not to accept in-network insurance. We ascribe to providing a standard of care WAY higher than the minimum dictated by insurance. Claims may be submitted out of network, but we cannot guarantee that your insurance company will pay (especially since we will probably list the primary condition treated as a non-medically required relationship issue). Canceling without 24 hours’ notice results in the full fee being charged, regardless of the reason. This who cancel with less than 24 hours’ notice will receive half off their next appointment if they attend within seven days. If we ever cancel on you with less than 24 hours’ notice (for any reason), your next session is free. This is because your time is valuable, and ours is as well. Check out the blog on cancellation for information on the policy (which is admittedly strict).
Fees for different options are shown below.
| Service | Reasons to choose this option | Reasons not to choose this option | Fee |
| A 50-minute session at $125 is appropriate to get to know you and begin helping you reach your goals (most common) | – You are already using this option and it is working – You want to get started with counseling. | – You find yourself running out of time or that 50 minutes isn’t enough | $125 |
| Couples Counseling 85-minute Session | – You have found that 50-minute sessions do not provide enough time – You have a long drive – You generally have plenty to discuss – You want improvements to happen faster – You want to save money on a per-minute basis | – You generally do not have a lot to discuss – It’s cost prohibitive – You can’t spare the extra time – You find 60 minutes is enough – May be overkill for monthly check-ins where things are generally going well | $175 |
| Couples Counseling 8, 85-minute session Package | – You want to make a commitment and force yourself to stick with it* – You are comfortable that your counselor is a good fit – You have a reasonable number of things to discuss – You want to save money on a per-session basis – You want free access to the Gottman Checklist assessment * Clients may decide to cancel unused sessions in writing for a fee of 20% of unused session times to cover card processing and refund fees and other processing fees. All payment is made upfront | – You have a single relatively simple issue such as communication – You do not want to make a commitment – You are not sure yet how much time you need – You do not have the money to pay for 8 sessions upfront | $1,200 |
| Intensive Therapy Two six-hour days | – You generally do not have a lot to discuss – It’s cost-prohibitive – You can’t spare the extra time – You find 60 minutes is enough – May be overkill for monthly check-ins where things are generally going well | – While working with the couple is preferred, sometimes both will not attend – You want to discuss relationship issues without your partner – You want to work on yourself as a means to improve the relationship – You want to focus on trauma, chronic pain, loss, grief, or other individual concerns. – Your intent is not to bash your partner but to understand how to improve the relationship even if they won’t attend. – Things are so bad that you can’t stay in the same room for even an hour with a mediator. – One person is seriously considering divorce and discernment counseling would be better. | $1600 |
“Good Faith Estimate” Law
Under the law, healthcare providers need to give patients who don’t have insurance or who are not using insurance an estimate of the bill for items and services, if so requested. Some interpretations are that this estimate is also required if not requested and before your first visit (most recent interpretations).
- You have the right to receive a Good Faith Estimate for the total expected cost of up to 12 months of services. The number of sessions you desire is at your discretion, and you can stop treatment at any time with 24 hours notice (or you may not reschedule future appointments). If you ever receive a bill that is more than $400 above the stated estimate, you have the right to dispute the charge. In fact, if a bill is $.01 higher than you expect, please ask us why. Optional pre-paid packages give you a certain number of sessions at a fixed price which is a discount over paying individually. Please realize that an estimate is only an estimate, and the total cost of therapy services is based on a number of variables involved. The cost depends on how often and frequently you want to attend, what your goals are, how much work you do outside of sessions, how well certain evidence-based interventions work for you, what happens in your life between starting and finishing counseling, how much is known at the point you want an estimate, and a variety of other factors. A good faith estimate is not a contract and does not obligate the client to receive any treatments they do not want.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises.