The Truth About Insurance and Couples Counseling in Texas
- Dr. Bernadette P. Smith
- Jul 24
- 2 min read
Do you ever wonder why it is so hard to find a couples counselor? Here's why:
Why Insurance May Not Cover Couples Counseling
If you’ve been trying to use your insurance for couples counseling, you may be experiencing some frustration, and you’re not alone in that feeling. Here's the truth: most insurance plans don’t cover couples or marriage counseling. That’s not because it’s not important. It’s because insurance companies don't define couples counseling as a “medical necessity.”
Insurance typically requires a mental health diagnosis, like anxiety or depression, to authorize payment. Since relationship struggles don’t qualify as a diagnosable condition, many claims for couples therapy get denied. Relationship concerns are considered a Z-Code in the insurance and diagnosis world, and Z-Codes are often not covered.
Even if one partner has a diagnosis, the focus of couples counseling is often on the relationship, not just one person’s symptoms.
Does Insurance Cover Couples Counseling?
Even when insurance covers the sessions with both partners present, it’s rarely straightforward.
Couples counseling isn't even considered a service, instead, these sessions are typically billed as individual therapy with a family member involved (code 90847). That means:
One partner must have a diagnosable mental health condition.
The therapy must primarily focus on treating that diagnosis, not the relationship as a whole.
Even then, reimbursement isn't always promised. Some insurance plans approve the claim, others don’t, and decisions can vary from one week to the next.
It’s confusing. It’s frustrating. That’s why many providers choose not to bill insurance for couples work. It allows them to focus on helping your relationship, without jumping through hoops or compromising care.
Ok, So What Are My Options If Insurance Doesn’t Pay?
Therapy is an investment, but that doesn’t mean it’s out of reach. Here are some common solutions:
Pay out-of-pocket for full flexibility and privacy.
Use HSA or FSA funds (most therapy sessions qualify).
Look for sliding scale rates or affordable options
Explore workshops or group programs focused on communication and connection.
At Aspen Counseling & Wellness, we understand the financial side of therapy matters. That’s why we offer:
Transparent rates with no surprise billing.
Receipts for potential reimbursement through out-of-network benefits.
Flexible scheduling
And a free 15-minute consultation to see if we’re a good fit before you make the financial investment.
The Big Picture
Every couple is different. If you're not sure how to move forward, let’s talk. That's what we are here for. We’re happy to walk you through your options, explain any costs clearly, and find the right support for your relationship.
Ready to invest in your relationship? Schedule a free consultation today to explore whether couples counseling is right for you. Find your next couples therapist here:
Toggle to Couples to find the counselors accepting couples
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