When you seek professional help for your relationship, you are looking for a space built on trust, clarity, and integrity. To maintain those values, our practice has a clear standard: We do not bill insurance for couples therapy.
While we do accept insurance for individual therapy, where the focus is on treating a specific person's mental health, applying that same model to couples work creates a significant ethical and clinical conflict. Here is why we believe that "working around" insurance rules is not the right way to handle your relationship care.
The Right Specialist Analogy
Think of it this way: If you went to an orthopedic surgeon to fix a broken leg, but mentioned you also had a heart condition, that surgeon wouldn't bill your insurance for "cardiology services." They aren't treating your heart; they are treating your leg.
The same applies here. Even if one partner in a relationship has a diagnosed mental health disorder (like Anxiety, ADHD, or Depression), we are not actively treating that disorder in couples therapy. We are treating the relationship. Billing insurance for a mental health disorder we aren't primarily treating is misrepresentative and, frankly, considered insurance fraud.
Avoiding Medical Misrepresentation
Insurance companies operate on a medical model. For them to pay for a session, a therapist must certify that they are treating a specific, individual mental health illness.
In most couples therapy cases, the "problem" isn't that one person is sick; it's that the relationship's communication, trust, or connection has broken down. If we billed insurance, we would be forced to claim we are treating an individual illness that may not be the focus of our work. We believe that misrepresenting your story to an insurance company is a breach of professional ethics. We choose to be honest about the work we are doing: treating your bond, not a diagnosis.
The Relationship is the Client, Not a Supporting Character
To get a claim approved, insurance requires an "Identified Patient." This labels one of you as the person with the "disorder," while the other is relegated to a "support" role.
This requirement forces a therapist to focus the treatment plan on one person's symptoms to justify the bill.
We believe that in couples work, the relationship is the client. By not billing insurance, we can remain 100% focused on the dynamic between you. We don't have to "pick a side" or pathologize one partner just to check a box for a corporation.
Protecting the Accuracy of Your Record
To justify "medical necessity" to an insurer, a therapist often has to use language heavily focused on individual pathology. This means the paperwork in your file would reflect a version of your therapy that is largely misrepresentative of what is actually happening in the room.
We refuse to let a bureaucratic billing requirement dictate the narrative of your growth. We want your clinical record to be an honest reflection of your journey toward relational health and not a list of individual symptoms used to secure a reimbursement check.
A Different Kind of Value
By choosing to pay out-of-pocket for couples therapy, you are ensuring that your sessions are:
- Your records reflect the real, systemic work you are doing.
- Neither partner is labeled as "the problem" to satisfy a billing code.
- Your therapist's clinical energy goes into your connection, not into justifying your life to an insurance adjuster.
At our practice, we hold ourselves to the highest ethical standards. We believe that starting a therapeutic relationship with a "work-around" regarding billing undermines the very foundation of honesty we are trying to help you build in your relationship. Doing things the right way ensures that your therapy is ethically rigorous and professionally responsible.
