Rates, Payment, and Insurance Questions
We understand that therapy is an investment, of both your time and your money. An investment into yourself and perhaps also into your relationship, and the therapists in our practice do everything we can to help you to maximize your investment. Rates for the standard 50-minute appointment are $160 for Hanna Kokko and Sheila Poquiz; $175 for Bill Aloe, Mary-lynn Ballew, Lisa Stewart, Corey Thompson, and Sara Whitney; $195 for Justin Pere. We do not charge more for the initial intake session, nor do we charge more for couples or family therapy than we do for individual therapy.
Health Savings Accounts and Flexible Spending Accounts
We are happy to run your sessions through your health savings account (HSA) or flexible spending account (FSA), which can be used to pay for medical expenses such as therapy (both individual and couples therapy) and can often significantly decrease the cost of treatment.
For individual clients, we provide invoices for reimbursement of whatever your out-of-network benefits will cover. Many of our individual clients choose to submit to insurance for out-of-network coverage, and what we most often see is 20-60% reimbursement (for example, Premera most often reimburses $94 per session). We encourage you to contact your health insurer to inquire about your out-of-network coverage, as each policy varies.
For couples/relationship clients, while we would love for you to be able to utilize your insurance benefits, the reality is that health insurance rarely covers relationship therapy, regardless of how great your plan is or even what your insurance company may have told you. We know that this is often surprising and unwelcomed news so we ask that you please take a few minutes to read the explanation below so that you can make informed decisions about your care.
Do you take our insurance for couples/relationship therapy? is a common question that takes a moment to answer (believe it or not this is the short version!)...
If your insurance company tells you that they do indeed cover couples counseling, they are referring to the following scenario: one person's mental illness is being treated and the partner is only present to support that person's mental health treatment. When health insurance is utilized for therapy, the insurance company will only cover mental illnesses, such as Major Depressive Disorder or Generalized Anxiety Disorder or ADHD. By definition, illnesses afflict one person at a time. Insurance is known to be somewhat flexible about how a mental illness is treated, meaning that if a spouse needs to be involved and present in the treatment of the mental illness, insurance will allow for that.
Please note that in this scenario, one member of the couple is officially diagnosed with a mental illness (considered the "identified patient" by the insurance company), and the treatment file and treatment progress notes that the therapist has to write and keep reflects ongoing treatment for that patient's mental illness. So again, in this scenario, couples therapy is only covered by health insurance because the treatment is focused solely on one partner's diagnosed mental illness, and the other partner is only present to be part of their spouse's treatment of their mental illness. Please also note that in this scenario, a valid mental illness needs to be assigned by the therapist and sent to the insurance company, where that diagnosis becomes part of the patient's permanent medical record.
If the person who will serve as the “identified patient” is already in individual counseling for that mental health diagnosis, the couples therapist cannot bill insurance, because the person is already receiving individual treatment for that diagnosis. Health insurers are assuming that couples therapy is always focused on the treatment of one spouse's mental illness.
The challenge is this: most couples do not enter couples therapy to work on one person's mental illness. They instead seek relationship counseling for help with communication, conflict, emotional connection, parenting, trust, sex/intimacy, and all sorts of other important reasons to seek help from a relationship counselor. But these focuses of therapy are not "medically necessary" mental illnesses, and thus the scenario described above does not apply, given that health insurance only pays for treatment of diagnosable mental illness. Additionally, the couple as a unit is the focus of therapy, and so billing insurance as if the couple's sessions are treating just one individual is potentially insurance fraud.
This is a frustrating reality for both the public and for therapists. We would love for couples to be able to utilize their insurance benefits for relationship help, but we are forced to adhere to the very strict rules around what is covered and what isn't. And we need to be careful because breaking these rules really can be insurance fraud.
*Please note: Very rarely, we do see some insurance carriers cover couples therapy. The way to clarify this with your insurance is to ask if your plan covers what is called a “Z Code” diagnosis, specifically the code Z63.0. As mentioned above, all insurance billing must include a mental health diagnosis (they want to know what they are paying for), and there is a group of relationship-related codes that start with Z (such as the Z63.0 example above, which is for “Relationship Distress with Spouse or Intimate Partner”), that most insurance plans exclude. Again, most insurance plans do not cover Z codes so it is unlikely that your insurance will allow for this to be the diagnosed reason for couples therapy, however it may be worth checking with your specific plan. The exact question to ask your insurer is this: "Does my policy cover diagnosis code Z63.0 for procedure code 90847 in an outpatient office setting?"
If a "Z code" is indeed covered by your specific insurance policy, we are happy to give you an invoice to submit to your insurer for whatever out-of-network benefits you have, so that you may receive some reimbursement.
We know that relationship therapy is not inexpensive - that it's an investment. And we do everything we can to help you to get the most out of your investment. Therapy sessions with us range from $160 - $195 for the standard 50-minute appointment, which is about average for this area and for the advanced training our therapists have.
So thank you for your patience in reading through all of that, and we know that understanding health insurance can be quite confusing so please always feel free to follow up with any questions you have.