Insurance Reimbursement Guide

Insurance coverage for couples counseling can be complex. In many cases, it is typically not covered because it’s considered “elective” and not medically necessary. However, when coverage is available, our services are often reimbursable through out-of-network insurance plans, depending on your provider and policy.

To be eligible for any type of insurance reimbursement, one partner must be diagnosed with a mental health condition. This is a requirement from insurance companies—not something unique to couples therapy. In such cases, your therapist will need to submit a diagnosis code tied to that condition for sessions to be considered medically necessary.

We strongly encourage clients to explore how having a mental health diagnosis on record might impact their insurance, employment, or other areas of life.

Whether you’re seeking therapy for relationship problems, virtual couples therapy, or in-person marriage counseling, we’re happy to help you understand your options and navigate your benefits.

Wolfe Counseling is not in network with any insurance panels, however, your therapist may be covered, and covered well, as an “out of network” therapist. Please note that exceptions typically include Medicaid and Kaiser, which do not offer out-of-network coverage for our services.

To maximize your chances of reimbursement, we recommend carefully following the steps outlined below. While many clients receive partial reimbursement, coverage is not guaranteed—insurance companies ultimately determine what they will and will not reimburse.

It is your responsibility to verify your specific benefits and understand how your plan covers out-of-network therapy. If you need help with this process, we’re happy to guide you.

In Colorado, Medicaid does not cover couples therapy. If you are using Medicaid and seeking individual counseling, you must see a therapist who is in-network with Medicaid. You cannot see an out-of-network provider for individual therapy if you’re using Medicaid.

However, if you are seeking couples therapy, Medicaid does not cover this service at all. In this case, you can see an out-of-network provider, including therapists at Wolfe Counseling, for couples counseling.

If you are on Medicaid and seeking therapy, please inform us so we can ensure that we are providing services that comply with Medicaid regulations. If affordability is an issue, we offer scholarships to help reduce the cost of therapy. Contact us for more details about our scholarship program and current availability.

Before starting therapy, it’s essential to contact your insurance company to understand your coverage and the specific types of sessions that are included or excluded. This helps ensure your therapist can provide care that has the highest chance of being reimbursed. Keep in mind that while diagnosis codes may sometimes be adjusted, CPT codes (for the specific types of therapy sessions) cannot be changed after the session has taken place, as this may be considered insurance fraud.

Here are a few important questions to ask your insurance provider before you begin therapy:

1. Is couples therapy covered by my insurance plan? Some insurance plans consider couples therapy “elective,” and therefore may not cover it.

2. What are my in-network and out-of-network deductibles, co-pays, and co-insurance rates? (Ask them to explain any terms you don’t fully understand!)

3. Is my diagnosis code covered? Your therapist may use a specific diagnosis code, so ask what it is and whether it’s covered under your plan.

4. Which of the following CPT codes are covered by my out-of-network policy? (Your therapist may use a different code, so confirm with them which one applies to your session):

   • 90834 – Psychotherapy, 45-52 minutes (individual therapy only)

   • 90837 – Psychotherapy, 53+ minutes (individual therapy)

   • 90834 + 90785 – Psychotherapy, 45-52 minutes with interactive complexity

   • 90847 – Family Psychotherapy (including couples therapy)

   • 90846 – Family Psychotherapy (without the patient present)

By having these details in hand, you’ll be better prepared to navigate your benefits and ensure that your therapy sessions are covered.

Make sure you have the following information/documentation from your therapist before calling your insurance company:

• ALL forms required by your insurance company (commonly available on your insurance company’s website). We usually require you to fill these out but are happy to help when needed. Contact us for assistance.
• Diagnosis Code (listed on your Invoice and/or given to you by your therapist):
  • Dx Code
  • Dx Code Name
• Invoice statement (provided by Wolfe Counseling administration. Contact us to receive an invoice. Please give 5 business days to process. Ensure that all the following information is listed on the statement:
  • NPI of the therapist
  • Tax ID for Wolfe Counseling
  • All dates of service should be labeled “PAID” (can also be listed as the “Form of Payment” being listed)
  • CPT Code should be listed for EVERY session

Under federal law, if you don’t have insurance or are not using insurance, you have the right to receive a Good Faith Estimate (GFE) for the expected cost of your medical care. This estimate should include the total cost of any non-emergency services or items, such as therapy sessions, medical tests, prescriptions, or equipment.

Your healthcare provider is required to give you this estimate in writing at least one business day before your scheduled appointment or service. If you’re unsure about any charges, you can also request a GFE from any provider before scheduling a service.

If the bill you receive is at least $400 higher than your GFE, you have the right to dispute the charges. Be sure to keep a copy (or a photo) of your Good Faith Estimate for your records.

At Wolfe Counseling, our therapists are independent contractors, which means they are responsible for providing you with a Good Faith Estimate and ensuring compliance with these requirements.