Is Family Counseling Covered By Health Insurance?

Is-family-counseling-covered-by-health-insuranceIt’s possible that your insurance policy covers family counseling. How can you find out? Here, we explore the practical steps you can take to verify coverage and detail the structure of typical insurance plan as related to mental health. Then, we invite your questions about insurance for family counseling at the end.

Will my insurance pay for counseling services?

It depends.

It is a good idea to check if your health insurance plan includes counseling benefits for you and your family. Family counseling is an important part of the addiction treatment process (or any issue which involves teen mental health). Successful sessions can help the family start functioning and communicating better and lower the negative impact addiction of one family member has on the others.

Here is what we advise you to do. First of all, call your health insurance company on the phone and ask if you have mental health benefits. If you do, you’ll also want to know:

  • How many sessions does it cover
  • How much does your plan cover for an in-network provider
  • How much does your plan cover for an out-of-network provider
  • What is your co-pay
  • Are there any deductibles
  • Do you need medical confirmation or approval from your physician

What should I ask my family counselor regarding insurance?

After you get answers from your insurance company, you will know for sure if your health insurance plan will cover family counseling sessions, or not. Also, don’t forget to communicate this with the provider of counseling services, medical facility, or the therapist directly. Important questions you’d like to ask include:

  • Are they in-network with your insurance company
  • Will they take care of the insurance paperwork
  • Do you need to pay them up front and then seek for reimbursement from the insurance company
  • Are sliding-scale fees offered (in case your insurance doesn’t cover family counseling)
  • Do they have any other out-of-pocket payment options that may fit your family economy

Insurance coverage for family counseling difficulties

Health insurance companies will pay for family therapy and counseling only if you or your teen are given a diagnosis. This is why counseling or therapy, although needed, will not be covered by insurance unless a doctor provides proof for medical diagnosis. The basic principles for securing insurance coverage are:

  1. A medical diagnosis is needed to confirm counseling as a medical necessity. On top of diagnosis, insurance companies may request treatment plans, reports about the treatment progress, and other personal information before they decide how much, if anything, will be covered.
  2. Insurance companies may only approve several sessions. They may only cover a certain number of sessions despite being told by doctors that more are needed. This can significantly interrupt the counseling therapy if you have no other ways to pay and continue family counseling.
  3. Companies may routinely check up on progree and/or discontinue coverage. If you’ve been approved for family counseling, insurance companies will, from time to time, review the progress and changes to determine whether or not there is still a need to pay for family counselling sessions.
  4.  You can complain about being unrightfully denied insurance coverage. If you have been denied for insurance coverage, be prepared to start an appeal process with the therapist or counselor, in order to get your rightful coverage. This process may last anywhere from several weeks up to a few months.
  5. Your counselor or therapist may not accept insurance. If your insurance plan covers family counseling, you can check the website of your health insurance company to find other counselors in your area that are in-network.
  6. Your health insurance plan does not cover mental health needs. Mental health coverage includes counseling, but if your insurance does not include mental health benefits, you won’t be able to get family counseling coverage either. This is usually the case with older insurance plans. You can switch to a newer health insurance plan after you do an investigation to determine which health plan will fit your families needs best.

Insurance coverage for family counseling questions

We hope the information provided in this text can help you find an insurance company or an insurance plan that will cover the costs for family counseling sessions. If there are particular questions you need answers to, contact your insurance provider or leave a comment in the section below. We’ll try to help as much as we can.

About Addiction Blog

Ivana Janevska researches and writes about substance abuse disorders for Addiction Blog. She is driven to help teens find appropriate addiction treatment so that they can make the most of life.

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