Is Family Therapy Covered by Insurance? What You Need to Know

Family therapy creates hope for better communication and deeper, stronger bonds. But often, practical questions follow close behind, like “How will we pay for this?” 

Understanding your insurance benefits is a big part of accessing care. Many families ask us, “Is family therapy covered by insurance?”

It’s a fundamental question, and while the answer isn’t always simple, we’ll help you figure it out.

We know that dealing with insurance can feel confusing. Our goal is to break down the process, explain standard terms simply, and give you clear steps to learn about your specific coverage. 

Taking care of your family’s mental well-being is essential, and financial concerns shouldn’t be a barrier if help is available.

Is Family Therapy Covered by Insurance? The Short Answer

Often, the answer is yes, family therapy can be covered by insurance. 

Thanks to laws like the Mental Health Parity and Addiction Equity Act (MHPAEA), many health plans must offer mental health benefits similar to physical health benefits.

However, coverage usually depends on something called “medical necessity.” This means the therapy needs to be related to treating a diagnosed mental health condition for at least one family member. 

For example, if a child’s anxiety is impacting the whole family, therapy sessions involving the family might be considered medically necessary to treat the child’s anxiety. 

So, while the answer to “Does insurance cover family therapy?” is often positive, specifics matter.

Here’s what affects coverage:

• Your Plan Type. Private insurance, Medicaid, and employer-based plans often include mental health care.
• Diagnosis Codes. Some insurers require a mental health diagnosis (like depression) to approve sessions.
• In-Network vs. Out-of-Network. Therapists who partner with your insurer (“in-network”) usually cost less than those who don’t.

Not sure where to start? We’ll walk you through it.

What About Couples Therapy?

This is another frequently asked question: “Does insurance cover couples therapy?” The situation is very similar to family therapy. Insurance plans generally don’t cover therapy just for “relationship improvement.”

However, couples therapy is often covered by insurance if one partner has a diagnosed mental health condition, and couples therapy is part of their treatment. 

Just like with family therapy, the focus needs to be on treating the diagnosed condition. Some plans might exclude marriage counseling, so checking the details is key. 

Always verify if couples therapy is covered by your insurance, specifically in your situation and plan, or if it’s handled differently. Finding clear information about couples therapy insurance means asking direct questions.

How to Check Your Specific Insurance Plan

The best way to confirm is to check directly with your insurance provider. 

Here’s how:

1. Call the Number. Find the member services or behavioral health phone number on the back of your insurance card. (You can also check their website or search for their contact details online.) Call them and ask specifically about your mental health benefits.
2. Check the Website. Many insurance companies have online portals where you can view your benefits details. Nowadays, many will also have bots to help make your search easier.
3. Review Your Documents. Read your Summary of Benefits and Coverage (SBC) or your full plan document.
4. Ask Us Directly. We help families verify benefits. Share your insurance details with us, and we’ll explain your options. 

Basic Insurance Terms Explained

• Deductible: The amount you have to pay out-of-pocket for covered services before your insurance starts paying. 
• Copay: A fixed amount (like $25) you pay for each therapy session after meeting your deductible.
• Coinsurance: A percentage of the cost you pay for each session after meeting your deductible (like 20% of the total fee).
• In-Network Provider: A therapist or clinic that has a contract with your insurance company. Seeing an in-network provider usually costs less.
• Out-of-Network Provider: A therapist who doesn’t have a contract with your insurance. Your plan might still cover some of the cost, but likely less than for an in-network provider.
• Pre-authorization (or Prior Authorization): Sometimes, your insurance company requires approval before you start therapy for it to be covered. Always ask if this is needed!

Important Questions to Ask Your Insurance Provider

When you call or check online, have these questions ready:

• Do I have mental health benefits for outpatient therapy?
• Is family therapy covered by insurance under my plan? 
  • What parts of family counseling are covered by insurance?
• Is couples therapy covered by insurance? 
  • What about couples counseling? 
  • What conditions apply?
• Do I need a specific diagnosis for coverage?
• Do I need a referral to get coverage?
• Do I need pre-authorization before starting therapy?
• What is my deductible, and have I met it yet?
• What is my copay or coinsurance for therapy sessions (both in-network and out-of-network)?
• Is there a limit on the number of sessions covered per year?
• Is Guided Grace Family & Youth Services, or a specific therapist, in-network with my plan? 
  • If not, what are my out-of-network benefits?

What If Insurance Doesn’t Cover It or Costs Are High?

If coverage is limited or therapy seems out of budget, there are still affordable paths to care.

• Some providers offer sliding scale fees based on income. 
• Employee Assistance Programs (EAPs) through work sometimes offer free short-term counseling. 
• As a community-focused nonprofit organization, we strive to make our services accessible by using donations to reduce the costs for those in need. 

Still Have Questions? Let’s Talk

If you’re unsure about your insurance benefits, our team is here to help. 

Visit us today to ask questions or schedule your first session. 

Together, we’ll find a path that works for your family!