Does insurance cover marriage counseling in Colorado? This guide by Pivotal Counseling, LLC explains how couples therapy coverage often depends on factors like medical necessity, CPT codes, and mental health benefits offered by your plan.
Understanding Insurance Coverage for Marriage Counseling in Colorado
People often ask, "Does insurance cover marriage counseling in Colorado?" Well, the answer isn't simple. It mostly depends on your plan and what's going on with you.
Most health plans don't pay for marriage counseling straight up. Why? Because feeling upset in a relationship isn't seen as a mental illness by insurance rules. Usually, insurance covers therapy if one person has a real mental health problem that affects the marriage.
Here's what you should know:
Medical Necessity: Insurance wants proof that therapy helps a medical problem.
Diagnosable Condition Requirement: If someone has a condition like Major Depressive Disorder or Generalized Anxiety Disorder, coverage might be possible.
Limitations of Coverage: Therapy must focus on the person's mental health diagnosis, not just on fixing couple fights.
The Medical Necessity Requirement and Its Impact
"Medical necessity" is a big word but just means therapy must treat a medical problem to get covered. For example:
- One partner might have Major Depressive Disorder and get counseling for both depression and related marriage troubles. Then insurance might help pay.
Therapists have to work mostly on treating the diagnosed issue while sometimes bringing in the other partner.
Think about these points:
Diagnosis Focus: Therapy should target the symptoms of the diagnosed illness.
Limited Scope: You can't get insurance to pay if you only want help with relationship fights without an official diagnosis.
Why Relationship Distress Alone Is Not Covered
Insurance companies use codes to decide what they will pay for. One is called Z63.0 — it means problems in a relationship with a spouse or partner.
The catch?
- Relationship distress isn't a mental illness that insurers cover.
This means if couples want therapy just for relationship troubles, they usually have to pay themselves. Insurance won't pay because these problems aren't "diagnosable" conditions.
When Insurance May Cover Couples Therapy in Colorado
Does insurance cover marriage counseling in Colorado? Well, it depends on your plan and situation. Most insurance plans cover behavioral health for mental health problems you can diagnose. But couples therapy or marriage counseling usually isn't covered by itself. That's because feeling upset in a relationship is not a medical diagnosis.
Insurance companies want a medical necessity to pay for therapy. That means one person must have a diagnosed mental health issue, like depression or anxiety, that makes life hard. If that causes problems in the relationship, some insurers might pay for a few couples sessions to help treat that person's condition.
In Colorado, marriage counseling insurance coverage can be different depending on who you get it from and what kind of plan you have. It helps if you check your mental health benefits and ask about how behavioral health insurance coverage works for couples therapy.
Coverage for Diagnosable Mental Health Conditions
Insurance usually pays when one partner has a diagnosable mental health condition. Things like Major Depressive Disorder (MDD) or Generalized Anxiety Disorder (GAD) fit this rule.
Here's how it works:
If one spouse has MDD and it messes with the relationship, therapy for depression may be covered.
Both partners can join sessions, but the focus must stay on treating the diagnosed person.
Pre-existing conditions often get covered if your plan says so. Still, ask your insurer before starting therapy to be sure.
This way, some couples can get help using coverage meant for individual diagnoses. But keep in mind, there are limits. Most time should target personal symptoms, not just relationship troubles.
Treatment Focus and Limitations When Using Insurance
Getting insurance to pay straight-up for "couples" or "marriage" counseling is pretty rare in Colorado. Plans don't see relationship problems alone as something to cover without a mental health diagnosis.
When using insurance:
Therapists need to focus on an approved mental health disorder.
The partner without the diagnosis can come but mostly supports the person getting treated.
Many couples therapists work outside of insurance because of these rules.
Because of this, lots of people pay on their own or try using out-of-network benefits if they have them. Knowing these rules helps you see what insurance will cover and what won't—so you're not surprised later.
In-Network vs. Out-of-Network Benefits in Colorado Plans
If you want insurance for couples counseling Colorado, it helps to know the difference between in-network and out-of-network therapists. Insurance plans have a list of providers they work with. These providers are called in-network therapists. When you pick an in-network therapist, your insurance usually covers more costs. That means you pay less out of pocket.
But here's the thing: many good couples therapists don't work as in-network providers. They might not join because insurance coverage for behavioral health is tricky or they don't want to deal with billing rules. So, you might need to see an out-of-network therapist instead.
In Colorado, mental health benefits change by plan but mostly cover treatment only from licensed pros your insurer knows. Sometimes specialty matters more than if a therapist is in or out of network. So finding the right couples therapist might mean going out-of-network.
What In-Network Coverage Means for Couples Therapy Access
Using in-network coverage makes marriage counseling cheaper for most people. When you go to an in-network licensed couples therapist, your insurance pays more after you meet your deductible and pay copays.
But wait—there's a catch. Many insurers see marriage counseling as family or individual therapy instead of couple sessions. Also, some therapists focus on types of therapy like CBT or EFT that may not be in your network.
Because of this, even if your health plan covers counseling benefits, you might find fewer in-network therapists who focus on couples therapy.
Here's what in-network coverage can do:
Lower your cost per session
Make billing easier
Let insurance handle most payments
But it can limit your choice if specialists aren't listed in the network.
Common Use of Out-of-Network Benefits for Marriage Counseling
Lots of people use their out-of-network benefits for marriage counseling because many expert couples therapists don't accept insurance directly.
Here's how it works:
You pay at each session first
Your insurer pays back some money later
How much you get back depends on your deductible and allowed rates
You have a special deductible just for therapy sessions, called an "out-of-network deductible." Once you pay that off, your insurance pays part of the cost but usually not all.
How to Verify Your Insurance Coverage
Checking your insurance for marriage counseling in Colorado can feel confusing. But if you follow these steps, you'll know what's covered and avoid surprises.
1. Gather Your Insurance Information
Find your insurance card. Write down your policy number, group number, and the customer service phone number.
2. Call the Customer Service Number
Use the phone number on your card to call your insurance company.
3. Ask About Mental Health Benefits
Ask if mental health services include couples or marriage counseling.
4. Check In-Network vs Out-of-Network Coverage
Ask if couples therapists are covered in-network or only out-of-network (OON).
5. Verify Specific Therapy Codes (CPT Codes)
Ask about coverage for these codes:
CPT 90847: Family therapy with patient present (used for couples counseling)
CPT 90837: Individual psychotherapy sessions
6. Inquire About Medical Necessity Rules
Ask if you need a diagnosis like depression or anxiety to get coverage.
7. Ask About Deductibles and Co-Pays
Find out how much you pay before benefits start and what co-pays or coinsurance you owe per session.
8. Learn About Submitting Claims & Superbill Usage
If you see an out-of-network therapist, ask how to send claims using superbills for partial refunds.
9. Confirm Limits on Sessions Per Year
Check if your plan limits how many therapy sessions it covers each year.
10. Take Notes During Your Call
Write down names, dates, times, and answers so you can check back later.
Key Questions to Ask Your Insurance Provider
When you call about marriage counseling insurance coverage in Colorado, try asking these questions:
Does my plan cover marriage counseling or couples therapy?
Is this under mental health services?
Are couples therapists in-network providers?
What benefits do I get with an out-of-network therapist?
Which CPT codes does my plan accept for couples therapy? (like 90847 family therapy with patient present)
Does code 90837 for individual psychotherapy apply if one partner goes alone due to medical reasons?
What proof of "medical necessity" do I need to qualify for coverage?
How do I submit claims with superbills after paying upfront at an out-of-network provider?
Are there limits on how many sessions are covered per year?
Asking these helps clear up what your insurance covers.
Considering the Cost and Value of Marriage Counseling
Marriage counseling costs can be very different from one place to another. Many insurance plans ask you to pay a therapy copayment or co-pay each time you go. You might also have to pay a deductible for therapy sessions before your insurance helps with the bill. The out-of-pocket therapy costs depend on your plan and how much your therapist charges.
Some therapists offer sliding scale therapy fees. These fees change based on what you can pay, which can help if money is tight. But, hmm, even with sliding scales, some people find it hard to keep up with regular visits because of financial barriers.
Still, marriage counseling gives helpful support when couples face hard times. Spending money on good care can help partners talk better and build stronger connections.
Assessing Whether Marriage Counseling Is Worth the Investment
Is marriage counseling worth it? Well, it depends on a few things:
Effective Therapy: Therapy works best when it uses proven methods made for each couple.
Patient-Centered Care: Therapists who listen well make plans just for you and your partner.
Commitment: Both people must take part actively to see changes.
Ongoing Support: Regular sessions help build skills over time instead of quick fixes.
Finding a skilled therapist who fits your needs matters more than just picking someone cheap or covered by insurance. Look at both skill and price when deciding about marriage counseling.
Finding the Right Licensed Marriage Counselor in Colorado
Picking a licensed couples therapist or a licensed marriage and family therapist (LMFT) can really help your relationship. These pros know a lot about how couples work together. In Colorado, many behavioral health providers offer counseling for couples. But not all of them focus on marriage therapy.
When you look for a counselor, put their specialty first, not if they take your insurance. A therapist who knows couples' problems will help you better than one picked just because of insurance.
If you want help with marriage counseling insurance coverage in Colorado or finding therapists who take your plan, check with Pivotal Counseling, LLC today—your path toward better relationships begins here!
