Marital counseling implies that you are going together to work through relationship issues, but if your focus is individual counseling, you just want your spouse to accompany, and support you, in managing your own individual mental illness. In the first case, your marriage will be the focus of attention. In the second case, helping you and your spouse learn better ways of managing the challenges of your mental illness will be the focus.


If you've determined that you want help for a troubled marriage, be aware that this will be considered your "diagnosis." This diagnosis code is V61.1 Relational Problems in the DSM V. Knowing the difference between a "diagnostic code" and a "procedural code" will be important when you contact your insurance company.;
, Most contracts have a clause that reads something like this: “A quote of benefits or authorization does not guarantee payment or verify eligibility. Payment of benefits are subject to all terms, conditions, limitations, and exclusions of the member’s contract at time of service.” This means that when you call up your health insurance company, you cannot rely on what the person tells you as a "fact." It may be, or it may not be. You are required to know your own health insurance plan.
 You are expected to understand what your health insurance policy covers, and what it does not cover. This can be confusing to most people. Most people believe that if a person from your health insurance company tells you it is so, then it is a fact. Not so. You have to be a savvy consumer and know what to ask.


Many policies state that they will pay only for treatment that they consider to be “medically necessary.” This meaning that they have the right to withhold payment if it is considered outside the scope of the policy. This is true even if you have an "authorization code."

, Will you be seen alone, with your partner, or with other family members?
The "Diagnostic Code" is what reason the patient has for seeking treatment. It describes the focus of the treatment, even if the patient has more than one accurate diagnosis. What will your clinician be focused on helping you with? This is the Diagnostic Code.

This is the most confusing part for most people. Your insurance will pay for both spouses being in the room (Procedural Code) and the clerk on the phone will say “Yes, we cover couples counseling,” because they see the Procedural Code “Couples/Family Therapy” on their computer screen. But a Procedural Code (Who’s in the Room) doesn’t kick out the claim. It is the Diagnostic Code that causes the claim to be rejected.
 When you read your policy, or call up your insurance company, ask specific questions:


"Do you cover diagnostic code V61.1 used for marriage counseling?" You want to determine whether they consider V61.1 Relational Problems to be a medical necessity.
Some treat code V61.1 differently than other mental disorder diagnoses. If they cover it, ask how many sessions they will cover.
Sometimes health insurance companies will cover a few sessions as "V61.1 Relational Problems," and then after these sessions are used, they expect the marriage counselor to label one of you as having a diagnosable mental disorder. You have a right to decide if this will happen, when your counselor is asked to provide such a label, and what that diagnosis will be.
 Some people decide that they do not wish to be given a diagnosis of a mental disorder, other than V61.1. They will negotiate with their marriage counselor for an affordable fee, in lieu of being given this diagnosis. This is your right.


Most will agree that marriage problems are stressful. This does not mean that you have to be given a diagnosable mental disorder to see a marriage counselor. If you are going for marriage counseling, that should be your diagnosis. If your health insurance coverage doesn't cover V61.1 Relational Problems, you can look for a better plan, or put your concerns in writing to them. Long-standing marital distress is linked to physical illness, and is nothing to take lightly. Paying now for this sort of help makes good business sense, as well as common sense.
Determine whether you are going for marriage counseling or individually focused counseling, accompanied by your partner.
Read your health insurance contract.
Be savvy as you research.
Know the lingo before you call your insurance company:


"Dates and Location of Service" is when and where you will be seen;
A "Procedure Code" is who will be seen.
Have your questions ready.
Explore alternative payment options.
{"src": "wikihow-all_test", "title": "How to Find Out if Your Health Insurance Will Pay for Marriage Counseling"}