One of the most common questions we hear is: “Does health insurance cover sex therapy?” The answer depends in part on what kind of therapy you’re receiving.
If sex therapy is being provided as couples or relationship therapy, insurance usually does not cover it simply because the relationship or sexual connection is the focus of treatment. Coverage may be different when sexual concerns are being addressed in individual therapy and the treatment meets the requirements of the person’s insurance plan.
As relationship therapists specializing in sex and intimacy therapy in Seattle, we know this can be confusing. Below, we’ll explain why couples-based sex therapy is usually private pay, what insurance companies may mean when they say they cover “couples counseling,” and what options you have when insurance won’t cover the kind of relationship therapy you’re looking for.
Why Doesn’t Insurance Usually Cover Sex Therapy for Couples?
Health insurance generally pays for treatment that meets the plan’s definition of medical necessity. In mental health care, that typically means treatment is connected to a diagnosable mental health condition and is focused on improving that individual’s symptoms or functioning.
That creates a mismatch for many couples seeking sex therapy. They may be coming to therapy because of differences in desire, sexual disconnection, communication problems, pain around intimacy, betrayal, recurring conflict, or changes in their sexual relationship. These are very real concerns, but the relationship itself is often the focus of treatment rather than one partner’s mental health diagnosis.
Sex therapy is also not a separate insurance benefit or billing category. Whether insurance may reimburse for treatment depends on the clinical focus, diagnosis when applicable, type of therapy being provided, and the specific insurance plan.
What Does Insurance Mean When It Says It Covers Couples Counseling?
Sometimes an insurance plan will cover a session that includes a spouse, partner, or family member. However, that does not necessarily mean the plan covers relationship-focused couples therapy.
Typically, insurance coverage in these situations involves:
- One person being the identified patient.
- That person having a mental health diagnosis that meets the plan’s requirements.
- The treatment being primarily focused on that person’s diagnosed condition.
- The partner participating because their involvement supports the identified patient’s treatment.
That is different from the kind of couples therapy many people are actually seeking, where both partners and the relationship between them are the focus of the work.
Can Insurance Help Pay for Individual Sex Therapy?
Sometimes. If sexual or intimacy concerns are being treated within individual psychotherapy and the treatment meets criteria for medical necessity, your insurance plan may provide reimbursement depending on your benefits.
Clarity Counseling Seattle is an out-of-network practice. For qualifying individual therapy, our therapists can provide monthly superbills that clients may submit to their insurance company for possible reimbursement. Coverage varies considerably by plan.
For relationship-focused couples or family therapy, Clarity does not provide insurance superbills. We have chosen not to structure ordinary couples therapy as treatment of one identified patient when the actual focus of the work is the relationship.
You can read more about our policies on our Fees, Payment, and Insurance Questions page.
Why Can’t a Therapist Just Bill Couples Therapy as Individual Therapy?
Therapists are responsible for making sure their diagnoses, documentation, and billing accurately reflect the treatment being provided.
If the real focus of therapy is communication, trust, sexual connection, conflict, or the relationship itself, documenting the sessions as treatment of one person’s mental health condition simply to obtain insurance reimbursement can create ethical, clinical, and billing problems.
For that reason, we believe it is important to be clear from the beginning about whether therapy is individual treatment or relationship-focused treatment rather than trying to make one type of care look like the other for insurance purposes.
What Should I Know Before Using Insurance for Therapy?
Using insurance can make therapy more financially accessible, and for many people it is absolutely the right choice. It can also come with considerations that are worth understanding.
Insurance reimbursement generally requires clinical information such as a diagnosis and treatment documentation. That information becomes part of the insurance and health-record system and may be reviewed in certain circumstances.
The implications vary widely depending on the diagnosis, insurance plan, profession, benefit, or application involved. Having received therapy or having a mental health diagnosis does not automatically prevent someone from obtaining life insurance, professional licensure, employment, or other benefits. If you have concerns about a particular situation, it is worth checking the requirements that apply to you before making decisions about using insurance.
What Does Couples and Sex Therapy Cost at Clarity?
Because relationship-focused couples therapy and sex therapy are generally private-pay services, we know cost is an important part of deciding whether therapy feels workable.
Our current 50-minute couples and relationship therapy fees range from $195 to $215 per session, depending on the therapist. You can see current rates and payment information on our Fees & Insurance page.
What Are My Options If Insurance Won’t Cover Sex Therapy?
If insurance won’t cover the kind of relationship or sex therapy you’re looking for, there are still several ways to think about cost:
- HSA or FSA funds: Some clients use Health Savings Account or Flexible Spending Account funds for therapy. Eligibility varies, so check with your plan administrator.
- Adjusting session frequency: Depending on your needs, meeting every other week may make private-pay therapy more manageable while still allowing meaningful work to happen.
- Focused, goal-oriented therapy: Being clear about what you most want to change can help you and your therapist use session time intentionally.
- Lower-cost therapy with a supervised clinical intern: Graduate-level clinical interns can sometimes provide relationship and sex therapy at substantially reduced private-pay rates while receiving ongoing supervision from experienced clinicians.
Can Working With a Clinical Intern Be a Good Lower-Cost Option?
For people who need a lower-cost option, working with a supervised clinical intern can be a great option. Interns are graduate-level clinicians completing the supervised clinical experience required as part of their professional training and are well-supervised.
One local option that we love is the Low Cost Therapy program at Steffen Counseling Services. Their clinical interns offer reduced-rate individual, couples, family, sex, and EMDR therapy. Their interns are currently in-network with Molina Medicaid for eligible individual and EMDR therapy; couples, family, and sex therapy remain private-pay services.
As Steffen Counseling Services explains:
“Clinical interns offer a unique experience because they are learning and developing as therapists while bringing current education and approaches from their graduate training into the therapy room. They also receive consistent supervision and consultation from experienced clinicians, providing an added layer of support and accountability throughout their work. For someone seeking affordable therapy, working with an intern can offer thoughtful, up-to-date care while also supporting the development of the next generation of therapists.”
Fees, insurance participation, and therapist availability can change, so we recommend checking their current Low Cost Therapy page directly if this option may be a good fit.
Making an Informed Decision About Sex Therapy
We wish insurance made relationship care easier to access. For now, understanding what insurance does and does not cover can help you make a more informed decision about what kind of therapy fits your relationship, your goals, and your financial situation.
If you’re considering sex therapy, the Gottman Institute also published an article we wrote about what to consider before starting sex therapy.
You can also learn more about sex and intimacy therapy, couples and relationship therapy, our rates and insurance policies, or our frequently asked questions.
If you’d like help figuring out whether Clarity is the right fit, you can start with our short inquiry form. We offer in-person therapy in Seattle and online therapy throughout Washington State.