Fees & Insurance

Are you thinking of using health insurance to cover counseling?

I encourage you to investigate all options and arrive at an informed decision regarding your health care before using your benefits. That may mean using your insurance, and it may mean making another choice. You can always decide to use your benefits, but you can’t undo many of the negative consequences of using them.

Using your health insurance means the required diagnosis of a mental illness

Insurance companies only pay for things that they deem to be “medically necessary.” This means that you have to be diagnosed with a mental illness and prove that it is impacting your life on a daily basis. It’s important to remember that having symptoms doesn’t necessarily mean that you meet the criteria for a mental illness.

What This Looks Like for Couples Who Want to Use Insurance

Be wary when an insurance company says that they “cover couples counseling”. They are not referring to marital and relationship counseling. They mean that they cover a procedural code for a spouse to be present in therapy.

The procedure code tells insurance how the therapy happened – were you seen alone or with your spouse. Most insurance will cover more than one person being in the room. So, they tell you that they cover couples counseling because they will permit your spouse to be in the room with you while you receive counseling for your diagnosed mental illness. Your spouse is being considered a support to you in your treatment. This is typically Procedural Code 90847: “Family psychotherapy, conjoint psychotherapy with the patient present.”

This isn’t the only thing they look at. Treatment not only includes the procedural code, but the diagnostic code. The diagnostic code tells the insurance company what mental illness the patient is being treated for. This is what they base medical necessity on. The diagnostic code for couples counseling is V-61.1, Counseling for Marital and Partner Problems. This is the code that is typically rejected by insurance companies for not being medically necessary. It’s like trying to get your dental insurance to cover cosmetic whitening or veneers. Not going to happen. Insurance companies view relationship problems much in the same way that they view cosmetic procedures – they may be great, but they aren’t medically necessary.

How Does A Couples Therapist Accept Any Kind of Insurance?

The therapist will typically have to diagnose one of you with a mental illness and then state that the other person is there in support of the partner. One partner may have a diagnosed disorder, but that alone isn’t the focus of couples therapy. The focus is on the relationship and typically, all other diagnoses are secondary.

There is also the real risk that labeling one person as the “patient” will unbalance the treatment and pathologize the partner. Couples issues are best seen as something that both of you are addressing together. Even subtle ideas that someone’s diagnosis can be blamed for all of the issues can create difficulties in therapy.

Understanding What a Diagnosis Means For Your Future

If you get diagnosed with something, you should be able to decide who gets access to that info and why. You lose control of that information when using insurance. A diagnosis says nothing about how you cope, what your strengths are, and which of the many symptoms you actually have. A diagnosis can follow you in school and be a barrier to doing certain jobs requiring healthcare related checks. Many schools and healthcare institutions are now instigating these policies to screen out employees who may be seen as “unstable” or cost too much money in mental health care and lost work days. If your condition warrants a diagnosis, you may want to have some say over how that diagnosis functions in your life now and in the future.

Loss of Confidentiality

A loss of confidentiality means a loss of control over who gets your information and what they use it for. Anything that is part of your file becomes a permanent part of your file. This means that when you apply for new health insurance, life insurance, and many types of jobs, they can require an authorization to release information to view your entire medical record. While you may not be denied coverage due to a preexisting condition, companies can charge much higher premiums because of having ever been treated for any mental health issue.

A diagnosis is not the only thing that becomes part of your file. Insurance companies require treatment plans, progress notes, and other types of personal information to determine what, if anything, they will cover. These details about your treatment should be private, but when using insurance, they are open and available to anyone with access. You don’t get to take that information out of your file whether or not you discontinue treatment. This can be devastating for some and a minor irritation to others. You’re the only person who can decide what’s right for you.

Loss of Control

An insurance company will often only approve a certain number of sessions even if more are necessary. They can deny your claim and it could take months to get reimbursement, if at all. This can interrupt treatment. It should be between you and your therapist to determine what happens in your treatment and how much of it you need. But, imagine an insurance agent sitting next to you in your session, clipboard in hand, making decisions about whether you truly “need” this therapy or not.

What Insurance Do You Take?

I am in-network for CDPHP. If you have a different insurance company and have out-of-network benefits, I’m happy to provide you with a statement that has everything you need to seek reimbursement from your company. If you are contacting your provider to see about out-of-network benefits, ask the following:

• How many sessions are covered?
• Do I have to meet my deductible first? Is there an out of pocket maximum?
• Do they require a treatment plan or detailed summary for reimbursement?
• Do they reimburse for V-Code 61.1 for couples counseling?
• What are the qualifications required of the therapist? What information do they need from the therapist?

Use Pre-Tax Dollars

Other options include using your Health Savings (HSA) or Flexible Spending Accounts (FSA) to pay for therapy using pre-tax dollars. I take HSA and FSA cards with major credit logos on them. If you don’t have one of these accounts, please speak with your tax preparer to see if you can deduct therapy expenses from your taxes as an out-of-pocket health expense.

Session Fees

Initial Session – $150

Subsequent sessions – $125

Couples sometimes find that a typical 50-minute session is not enough time to fully address their concerns and may book 80-minute sessions at the rate of $175 per session. 80-minute sessions must be arranged in advance.

Payment Methods

I accept cash, check, credit cards, and FSA or HSA with credit card logos. All payments are due at the time of session. Please note that there is a $30 fee on all returned checks.

Missed or Cancelled Appointments

Your session time is reserved specifically for you. If you cancel with less than 24-hours notice or do not show for your appointment, I am unable to fill that time slot with another client. I am also unable to bill insurance for missed sessions. I ask that if clients must cancel any scheduled appointments, they kindly provide a minimum of 24-hours notice. Clients who do not provide 24-hours notice or who are a no show for their appointment will be charged the full session fee depending on the amount of session time booked.



579 North Greenbush Road
Rensselaer, NY 12144

sarah@sarahmcclanelmhc.com
(518) 506-0346

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