Why Couples Therapy Isn’t Covered by Insurance (Even If I’m In-Network)
If you’ve been searching for couples therapy and noticed that many therapists don’t accept insurance for it, you’re not alone — and you’re probably wondering:
“If you're in-network with my plan, why can’t we use it for couples therapy?”
It’s a great question. And the answer isn’t about therapists trying to be inaccessible — it’s about how insurance companies define mental health treatment and what they’re actually willing to reimburse.
Let’s break it down.
The 90847 Code — and Why It’s Not “Couples Therapy”
There is a code that sounds like it should cover couples work: 90847 – Family or Couples Therapy with the Patient Present.
But here’s the catch:
This code is meant to support the treatment of one identified patient — someone with a mental health diagnosis that meets medical necessity criteria.
In this case, a partner (or family member) can be brought into a session to support that person’s care — like helping someone with anxiety navigate conflict, or working with a parent on skills that support a teen’s treatment.
That’s not the same thing as couples therapy. It’s not about mutual healing, exploring patterns, or repairing trust between two partners. It’s about helping one person’s mental health improve.
So What Is Couples Therapy?
Couples therapy focuses on the relationship itself — not one person’s diagnosis.
When both partners are equally involved, both are invited to be vulnerable, both are supported and challenged — that’s relational work. It doesn’t center one partner’s symptoms. It centers the dynamic between them.
That’s the work I do.
And unfortunately, that’s the work insurance companies don’t usually cover.
Why Insurance Doesn’t Cover Relationship-Focused Therapy
Even when you see a therapist who is in-network, insurance only covers treatment that meets medical necessity — meaning:
There must be an identified patient
That person must meet criteria for a mental health diagnosis (like anxiety, PTSD, or depression)
The treatment must focus on reducing symptoms and improving functioning related to that diagnosis
If the goal of therapy is to strengthen your relationship, repair trust, or navigate conflict together, that work doesn’t meet the medical necessity criteria — because the focus isn’t on one person’s mental health symptoms.
This is why even though there’s a billing code for family or couples sessions (90847), insurance companies won’t approve it unless the session is clearly about supporting the individual treatment of the identified patient.
Why I Offer Couples Therapy as Private Pay
To bill insurance, I’d need to do one of two things:
Assign a diagnosis to one partner and make the treatment plan about them
Document every session as if it’s about that person’s condition, even when we’re working on trust, communication, infidelity, or emotional safety as a couple
I don’t feel that’s honest, ethical, or fair — to either of you, or to me.
Couples therapy requires vulnerability, accountability, and safety. It shouldn’t start with paperwork gymnastics or a label that only tells part of the story. That’s why I offer it as private pay only — so we can do the work the way it deserves to be done.
Have Questions? Let’s Talk.
If you're unsure what kind of support you need, or if you're wondering whether your situation might still be eligible for insurance reimbursement under individual therapy, I’m happy to offer a free 20-minute consultation.
We can explore what feels like the right fit — and make sure it aligns with the work you want to do.
You deserve care that honors the full complexity of your relationships — not just what fits on a billing form.