Where's the insurance dictionary when you need it?
Steven M Cohn, PhD, LMFT
The Portland Couples Counseling Center
1940 NE Broadway
Portland, Oregon 97232
Many clients attempt to collect reimbursement for marriage counselors or relationship therapists. But, few, if any, insurance companies will pay regardless of whether you live in Eugene, Oregon or Bend, Oregon or in the Pearl District in Portland, Oregon.
Unfortunately, insurance company employees often give out misleading and/or incorrect information when couples counseling clients phone to find out if they are covered.
Often an insurance company employee will state that "the company does pay for marriage counselors" or "don't worry, you have mental health coverage." Then the client runs into the insurance system catch-22 for marriage counselors.
The catch-22 is that there is only one possible diagnosis that a mental health practitioner can apply to a couple. The insurance companies won't pay for that diagnosis, even if they tell you that you are covered for marriage counselors or relationship therapists.
To find out if your insurance company will actually pay for marriage counselors, you must ask the following question:
It's worth asking your insurance company if they will pay for that diagnosis, but be persistent and specific or you will end up with the wrong information. There's just no perfect insurance dictionary. Most insurance companies will not pay for a vee-code diagnosis of any kind. Before you call, it's important to understand the billing codes.
Sometimes clients will ask if they can pay for couples counseling using consumer-directed healthcare accounts like FSAs, HSAs, HRAs, DCFSAs or LPFSAs. The answer is no. Under IRC 213(d)(1), “Medical care will pay for the diagnosis, cure, mitigation, treatment, or prevention of disease, or for the purpose of affecting any structure or function of the body. This includes medical equipment, supplies and devices."
Marriage counseling does not directly relate to the diagnosis, cure, mitigation, treatment or prevention of a legitimate medical condition, and therefore would not be eligible for reimbursement with consumer-directed healthcare accounts like FSAs, HSAs, HRAs, DCFSAs or LPFSAs.
Caveat: Because laws change often, please check with your CPA or attorney to confirm this information is accurate.
The next issue that almost always comes up is the couples counseling client asking the marriage counselor, "Can't you just bill one of us or bill us separately?"
Sorry, but the answer is "No."
Billing an individual for a marriage counseling or relationship counseling session (which means you have to submit an actual diagnosis for that individual) is insurance fraud. Both the therapist and the client might be put at risk for both insurance fraud and conspiring to commit insurance fraud. Additionally, the therapist might be at risk for using the therapy office to commit a crime.
Steven M Cohn, PhD will not submit an insurance claim for an individual client when he is treating a couple.
Additionally, the individual sessions that Steven Cohn holds
during his four-session intake are for the purposes of marriage
counseling. The diagnosis remains the same "Z71.89 Other Specified Counseling" even if only one person is in the room.
Steven Cohn, PhD regrets the decisions that have been made by insurance
companies and the legislature. Perhaps one day a functional insurance
dictionary will exist to help you understand whether you are covered for
marriage and relationship counseling. For now the DSM V is the "Insurance Dictionary" used to define marriage and relationship counseling.
Steven M Cohn, PhD is honored to have been featured on CNBC.com.
Steven M Cohn, PhD is pleased to have been featured on Koin 6 Television: "Boost In The Bedroom."
Steven M Cohn, PhD is pleased to have been featured on both KATU.com and KATU Channel 2 Television.
Steven M Cohn, PhD is pleased to have been featured on Oregon Live "Why Oregon's Latest Divorce Statistics May Be Divorced From Reality"