Fee-for-Service Couples Therapy:

One of the most common questions from couples is, “Can we use our insurance for this?”  It’s a great question, and we’d like to walk you through the ethical reasons behind why we don’t take insurance for relationship or couples counseling and we also do not provide superbills.

Health Insurance Is Built for Individuals, Not Relationships

To use your health insurance for psychotherapy, three things are required:

1. An identified patient
2. A DSM-V Axis 1 diagnosis
3. A treatment plan that directly addresses the diagnosis—for that one client

In individual therapy, this works well. For example, if an individual is struggling with anxiety, they may be diagnosed with an anxiety or adjustment disorder and can be treated using evidence-based interventions. That’s clear, ethical, and reimbursable by insurance. But in couples therapy, things are different.

Relationships Aren’t Diagnosable—People Are

In couples work, the relationship—not one partner—is the client. But insurance companies don’t recognize relationships as billable “clients.” They want to know which person has a diagnosis, and how treatment is helping that individual. Even when they allow “family sessions,” they still require an identified patient. So a couple might attend therapy, but treatment would be framed as though one partner’s anxiety, depression, or trauma, is the target and the partner is there to support treatment. That’s not couples therapy. 

The “Relationship Distress” Diagnosis Doesn’t Count

There is a diagnostic code for relationship issues: Z63.0 – Relationship Distress with Spouse or Intimate Partner. But insurance companies won’t reimburse for it. 

So Why Do Some Therapists Bill Insurance Anyway?

You may have seen a couples therapist who did bill insurance. That doesn’t necessarily mean they were doing something wrong—but it does mean they were likely using a workaround:

• Diagnosing one partner and coding sessions as either “Individual Psychotherapy”, or “Family Psychotherapy, with Individual Present”
• Focusing, at least in their clinical notes, on that one partner’s symptoms with the other in a “support role”
• Hoping the insurance company never audits the records

Some therapists believe this is ethical, that perhaps the outcome—stronger relationships—justifies the workaround. After consulting with trusted colleagues, trainers, and insurers, we’ve chosen not to go that route. It just doesn’t align with our ethics or how we practice.

Why Paying Out of Pocket Might Be Worth It

When you pay for couples therapy privately, here’s what you’re getting:

• No diagnosis required—you’re not labeled with a disorder
• True confidentiality—no audits from insurance companies or the Federal government, no service or diagnosis codes on your record
• Access to specialized care—our therapists are trained specifically in effective couples treatment, including Emotionally-Focused Couples Therapy (Sue Johnson) & Relational Life Therapy (Terry Real)

Couples therapy is an investment, not just in your relationship—but in your emotional, relational, and even physical well-being. If you’re ready to work on your relationship, your therapist is there for the both of you—no diagnosis required.