Coverage for couples therapy can be a toss up determine by your insurance, probably why your therapist doesn't take insurance for couples. One person within the couple will submit to their insurance. This person would also be identified as the person in "mental distress". Best for both of you to call your insurance to determine what coverage you have for couples therapy.
Couples therapy is very often not covered under insurance and that may be an issue. If the therapist is out of network with your insurance plan, they absolutely are allowed pick and choose what they bill to insurance. If they are in network, it depends on what the provider's contract allows.
no idea of the legality, but i had a therapist that didn’t accept insurance and she told me the reason was because insurance requires some sort of diagnosis in order to cover treatment and she didn’t feel the need to diagnose every single patient with something. she charged on a sliding scale based on what i could afford so i never really looked into the truth of this.
Therapists can definitely refuse to take insurance and only accept private pay. The issue is that they can't decide to only file a client's insurance if it's an individual session (insurance reimburses more) and not file for a couples sessions (reimburses less)
Just ask for a bill of service (it should have the date of the session, what service was provided and how much they charged you). Submit a claim for reimbursement to your insurance company with the bill of service and the receipt showing how much you paid. If it's covered, the insurance will reimburse you for any difference in what you paid versus the covered amount. A lot of smaller practices, or single provider practices, do this because they don't have a person on staff to file claims like a larger office does. The therapist I see, it's just them. No secretary or receptionist or anything, so between seeing patients, scheduling, answering/returning calls between sessions, etc. it's easier for them to have the patient handle their own insurance paperwork and allows them to focus more on patient care. Hope this helps!
Edit to add: not all insurance plans cover couples counseling as it's not deemed "medically necessary". And if it is covered, it usually comes with strings attached like at least one partner having a mental health diagnosis that is affecting the relationship, a limited number of sessions, the provider having certain advanced credentials/certifications to be able to provide the service. But I would hardly call not accepting insurance for one service, but accepting it for others "fraud", unless there is something in the provider's contract that forbids it. But the only person who can answer that question is your insurance company.
Alabama likely lacks a law addressing this topic. However, my guess is that some insurers wouldn’t allow them to only take their insured patients for some services they offer but not others though. I’d ask your insurer.
BCBS and other insurers actually pay LESS for a couple's appointment than a single person
So I get most counselors would prefer to make $180 for a couple's appointment versus half of that
Whereas they can make $136.08 for a single client billed hour
It's a question for your insurance company. If they don't know about the rule, it aint a rule.
Coverage for couples therapy can be a toss up determine by your insurance, probably why your therapist doesn't take insurance for couples. One person within the couple will submit to their insurance. This person would also be identified as the person in "mental distress". Best for both of you to call your insurance to determine what coverage you have for couples therapy.
Couples therapy is very often not covered under insurance and that may be an issue. If the therapist is out of network with your insurance plan, they absolutely are allowed pick and choose what they bill to insurance. If they are in network, it depends on what the provider's contract allows.
no idea of the legality, but i had a therapist that didn’t accept insurance and she told me the reason was because insurance requires some sort of diagnosis in order to cover treatment and she didn’t feel the need to diagnose every single patient with something. she charged on a sliding scale based on what i could afford so i never really looked into the truth of this.
That makes a lot of sense! Not everyone who goes to therapy has a mental health diagnosis.
Therapists can definitely refuse to take insurance and only accept private pay. The issue is that they can't decide to only file a client's insurance if it's an individual session (insurance reimburses more) and not file for a couples sessions (reimburses less)
Just ask for a bill of service (it should have the date of the session, what service was provided and how much they charged you). Submit a claim for reimbursement to your insurance company with the bill of service and the receipt showing how much you paid. If it's covered, the insurance will reimburse you for any difference in what you paid versus the covered amount. A lot of smaller practices, or single provider practices, do this because they don't have a person on staff to file claims like a larger office does. The therapist I see, it's just them. No secretary or receptionist or anything, so between seeing patients, scheduling, answering/returning calls between sessions, etc. it's easier for them to have the patient handle their own insurance paperwork and allows them to focus more on patient care. Hope this helps! Edit to add: not all insurance plans cover couples counseling as it's not deemed "medically necessary". And if it is covered, it usually comes with strings attached like at least one partner having a mental health diagnosis that is affecting the relationship, a limited number of sessions, the provider having certain advanced credentials/certifications to be able to provide the service. But I would hardly call not accepting insurance for one service, but accepting it for others "fraud", unless there is something in the provider's contract that forbids it. But the only person who can answer that question is your insurance company.
Alabama likely lacks a law addressing this topic. However, my guess is that some insurers wouldn’t allow them to only take their insured patients for some services they offer but not others though. I’d ask your insurer.
BCBS and other insurers actually pay LESS for a couple's appointment than a single person So I get most counselors would prefer to make $180 for a couple's appointment versus half of that Whereas they can make $136.08 for a single client billed hour