Dear Dr. Centore:
I’m a Licensed Professional Counselor in private practice in WI and have a question regarding insurance reimbursement for what is termed “relationship issues.” For years, it has been my understanding that most insurance networks will cover couples counseling or family counseling if it is provided as a treatment for at least one person who has a DSM IV Axis I diagnosis. However, a few insurance companies have recently stated they won’t cover “relationship issues.” It seems almost anything is a relationship issue. Is this terminology an even broader restriction on covered services? Or is it still the case that “relationship issues” are covered as long as they are addressed as part of treatment for an Axis I diagnosis? Any input you can give on this would be helpful.
Thank you for your work for the ACA.
Mary E. B., MS, LPC, NCC
When a counselor provides help for couples, the session is generally billed as a 90847, which is identified as “Family Therapy with Patient Present.” You are correct that health insurance often does not pay for sessions where the presenting diagnosis is “relationship issues.” I also understand, that clinically-speaking, there are a number of philosophies and counseling theories that identify “relationship issues” as a core problem and contributing factor to psychotherapy at large.
However, health insurance covers that which is medical. Hence, alternative diagnoses that might (and in some cases might not) fit in the instance of a 90847 include Adjustment Disorder, as well as a variety of Depressive Disorders, or Anxiety Disorders.
Anthony Centore Ph.D.