One of the most common questions we hear is: “Does health insurance cover sex therapy?” Unfortunately, the answer is almost always no. While we would love for couples to be able to use their insurance benefits for sex therapy or relationship counseling, the reality is that health insurance rarely covers this type of treatment. And even when an insurance representative says they do, there are significant limitations and caveats that many people aren’t aware of.
As relationship therapists specializing in sex therapy in Seattle, we know that navigating the world of health insurance can be frustrating and confusing! Below, we’ll break down exactly why sex therapy for couples isn’t covered, what that means for couples seeking help, and how to make an informed decision about your care.
Why Doesn’t Insurance Cover Sex Therapy for Couples?
The main reason health insurance doesn't cover sex therapy for relationships is that insurance companies only pay for treatment that is considered “medically necessary.” This means that therapy must be used to address a diagnosed mental illness. Since couples in sex therapy are primarily focusing on relational and emotional concerns—rather than a specific, diagnosable mental health condition—it doesn't meet the insurance industry’s criteria for coverage. Most sex therapy happens in the context of couples therapy, as sexual concerns are often relational in nature, which butts up against the factor of insurance companies not covering couples counseling unless one partner has a diagnosed mental illness and the therapy is specifically treating that person’s condition.
Understanding How Insurance Defines “Couples Counseling”
If your insurance company tells you they cover couples therapy, they are likely referring to a very specific scenario:
- One partner has a diagnosed mental illness (depression, anxiety, PTSD, etc).
- The therapy sessions are focused on treating that person’s mental illness.
- The other partner is only attending to support their spouse’s treatment.
In this scenario, the insurance company considers the therapy to be individual treatment—not actual relationship counseling. The diagnosed partner is referred to as the “identified patient,” and all documentation (progress notes, treatment plans, other forms) must reflect that the sessions are solely focused on that one partner's mental health treatment.
Why This Doesn’t Work for Most Couples
Most couples don't seek therapy because one person has a mental illness. Instead, they come to therapy to improve their communication, rebuild trust, enhance intimacy, resolve conflicts, or work through challenges in their relationship. These are all valid and important reasons to seek therapy, but because they are not classified as treating a diagnosable mental illness, they just don't qualify for insurance coverage.
Attempting to bill insurance for couples therapy as if it is individual therapy… when the true focus is on the relationship…is considered insurance fraud. Ethical therapists can't misrepresent the purpose of therapy in order to get insurance reimbursement, even if a couple wishes to do so, as that risks our licenses.
What About the Risks of Using Insurance for Couples Therapy?
Even in cases where therapy is billed under an individual’s diagnosis, many people are woefully unaware that having a mental illness diagnosis on record can have lasting consequences. Once a diagnosis is submitted to an insurance company, it becomes part of that individual’s permanent medical record.
This can impact, if not downright cause rejection for, future applications for:
- Life insurance policies
- Long-term care insurance
- Military or law enforcement careers
- Firefighting positions in certain districts
- Pilot’s licenses
Before deciding to use insurance for therapy, it’s important to weigh these potential risks.
The Reality: Couples Therapy & Sex Therapy in Seattle Are an Investment
We completely understand that therapy is a financial investment, and we wish the system allowed for more support when it comes to relationship counseling. However, because of the strict regulations around what insurance will cover, couples therapy and sex therapy are almost always private-pay services.
Our therapy sessions range from $175 - $195 per 50-minute session, which is consistent with rates in this area and reflects the advanced training and expertise of our therapists.
What Are My Options If Insurance Won’t Cover Sex Therapy?
Even though insurance doesn’t cover relationship therapy, there are ways to make it more manageable:
- Using a Health Savings Account (HSA) or Flexible Spending Account (FSA) to pay for sessions.
- Scheduling sessions at a frequency that fits your financial situation: many couples find that biweekly sessions are very much able to provide significant benefits.
- Prioritizing short-term therapy with clear goals, so you can get the most value from each session.
Informed Decisions
We know this can be disappointing and unexpected news for many couples, and as consumers ourselves, we have the same gripe. But we also believe that having all the facts helps people make informed decisions about their care. While health insurance may not cover sex therapy for couples in Seattle, investing in your relationship is one of the most valuable things you can do. Additionally, the Gottman Institute posted a blog that we wrote for their site about contemplating starting sex therapy, which could be a helpful adjunct read.
If you have any questions about how therapy works, payment options, or what to expect, they may be answered on our rates and insurance page or our FAQ page. Our team of experienced therapists provides high-quality relationship therapy in Seattle and through online couples therapy, specializing in relationship and intimacy challenges.