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) and specific treatment for that same condition(s). 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 bit of 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 and using the Gottman method employs many techniques that are not specific to a mental health condition. Some providers use insurance with couples counseling by listing the primary client, diagnosing them with a mental health condition, and using couples therapy to treat that condition (e.g. anxiety caused by marital issues). Some providers may focus only on how your relationship impacts your condition as the primary client and only focuses on the primary client’s goals. Some 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, but 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 what we believe is the only ethical option. 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 it is more cost-effective to pay with an HSA, FSA, credit card, debit card, or cash. 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 doctor.
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 things like life insurance approval or cost or acceptance to medical school or the military. Paying in cash does not require a diagnosis to go on your record and would only if you request it. Dealing with insurance is also time-consuming and takes time away from our 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. 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 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|
|Free Initial Consultation||– You have questions|
– You want to find the right fit before spending money
– You want a more complicated scenario like an 8-session package
|– You would rather call or email questions without an appointment|
– You don’t have questions or don’t want to delay your first appointment
|Initial Couples Session||– Your first official session outside a consultation. This used to be 50 minutes but has been changed to 75 to allow for sufficient information gathering.||It’s not your first session 🙂||$175|
|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
|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 15% 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
|Couples Counseling 50-minute session||– For all of the reasons 85 minutes sessions may not be the best|
– You are already using this option and it is working
|– You find yourself running out of time or that 50 minutes isn’t enough||$125|
|Pre-Marriage Counseling||Intended for engaged couples, couples considering engagement, and for those whose primary objective is to talk about topics related to preventing future marriage or commitment problems.||$125|
|Couples Coaching||– Intended for out-of-state clients who want help with relationship issues|
– The intent is not to treat mental health disorders but relationship issues
|– You live in Ohio|
– You want diagnosed mental health issues to be a focus
|Individual Counseling||– 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
– Your intent is not to bash your partner, but to understand how to improve the relationship even if they won’t attend
– If your partner will attend with you most of the time, that typically works best
“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.
- You have the right to request and 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 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. If you would like an estimate for services for up to a 12-month period, you will be provided with one. 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. A good faith estimate for counseling is not likely to be very accurate unless you know how many sessions you want in a year (in which case it’s just the cost multiplied by the number of sessions). we do not believe this law was intended with counseling in mind, but are happy to do our best to support you and the law.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises.