Guide my search for remote couples counseling

February 10, 2023 12:35 PM

I am starting the search for a couples counselor and feeling a bit lost. We're hoping for what I think is some pretty basic help with communication skills, but it needs to be 1) remote and 2) covered by insurance, either Medicare or Blue Cross. There are a bunch of online platforms now and I have no idea how to tell which ones are good and which are garbage. Or maybe they're only going to have cut rate therapists and I should find an independent therapist and ask if they will work remotely and take insurance? What should I be doing here?
posted by HotToddy to Human Relations (9 answers total)

Do you have an EAP (Employee Assistance Program) at either one of your employers? If so, they'll hook you up. If not, start with your insurance company, they should have a list of providers. Most therapists are doing remote at this point so the fact that you're looking for remote is not really a huge limiting factor (it's much harder to find in-person).
posted by rabbitrabbit at 12:44 PM on February 10, 2023

Most independent therapists work remotely now as well.

You can try to find a therapist on :

psychology today

therapy den

inclusive therapists

The profiles will include what insurance they take or you can search by your insurance.

"online therapy" companies like Better Help track data, pay therapists abysmally, and do unethical things like give clients access to therapists via text throughout the week, for continued therapy.
posted by bearette at 12:50 PM on February 10, 2023 [6 favorites]

It can be really hard to find a therapist who takes insurance because the paperwork is a nightmare, especially if you're a single operator. What you can do is ask if the therapist will write you a letter with an appropriate DSMV code and then you can file with your insurance to reimburse you for the therapy. That's what I've done in the past. I pay the therapist the full amount, submit invoices and codes to my insurance company and then they send me the reimbursement check.
posted by brookeb at 1:53 PM on February 10, 2023 [2 favorites]

Unless your need for couples counseling is prompted by one of you having a mental health diagnosis, it’s unlikely that health insurance would pay for any of it. Check your plan documents for sure.
posted by expialidocious at 2:48 PM on February 10, 2023 [2 favorites]

I am a therapist in a couple of networks (insurance companies). I do not find the paperwork to be anything like a nightmare. (Medicare may be worse than the private insurers, though. I'm not a Medicare provider). Every 3 months I fill out a form per patient. I've already pre-filled it with the patient's name, address, plan name, member number, diagnosis, etc. -- Really everything except dates of service. It's actually a breeze. I don't know why therapists are finding this so difficult. Am I just lucky? OR is this an excuse that therapists use for remaining out of network? The only downside of being in-network is the COMPENSATION.

Okay, as far as being compensated by the insurance company after the fact, as brookeb suggests, this ONLY happens if you happen to have out-of-network benefits for outpatient mental health, and many people (I'd guess MOST people, but I'm not sure) do NOT have any (because employer insurance mostly sucks).

SO --- You must call your insurance company and ask if you have any out-of-network benefits before you go and get yourself a therapist who will not accept any insurance plans (they all tell you, "oh, but I'll write you a Superbill you can submit to your insurance company!" Thanks a lot. Of COURSE you'll write them a bill, even if they don't have insurance! People want/need bills for their records. Oh, your bill will have their DSM-diagnosis and code for what service was rendered. What doctor doesn't give a patient that? This is not a gift.)

So - where do you find a therapist that takes your insurance? it's horrible, but your best bet might be Psychology Today, plug in your info as required, including your insurance, and start making calls. You will get tons of people who checked off the networks they're in, and then, guess what, they're not in network after all. (Bait and Switch). OR go to your insurance company website, go to FIND A DOCTOR --- sometimes behavioral health is a different website -- you'll see when you look at the menu --- and just call, call, call, and call until maybe you find somebody who still is looking for in-network patients.

It is a horrible process. As far as those new network things (not insurance companies), they tend to be baby therapists (I mean they're young, not that they do therapy with babies). BUT who knows, somebody might be good.

I would try to find people who at least SAY they have training with couples, and ask them about that when you call them.

Sorry to be so negative! it's a therapy jungle out there (I've been doing this work since 1982).
posted by DMelanogaster at 8:16 PM on February 10, 2023 [6 favorites]

Check out ZocDoc, a directory that filters by which insurance networks a practitioner claims to be in-network with.

Also, many of the COVID-conscious therapists in this directory do telehealth.
posted by brainwane at 2:00 AM on February 11, 2023 [1 favorite]

yeah, I forgot about ZocDoc. I get my own doctors there. It's a great resource.

oh -- as far as needing a DSM diagnosis to get couple therapy (or any therapy). This is not an issue whatsoever. Are your relationship problems stressing you out? of course they are, or you wouldn't be seeking therapy. So you have an Adjustment Disorder (adjustment to the stressor of relationship problems). There are various ways to frame this diagnostically.

Mental health diagnoses, despite what some people think, are a "soft science" (at best). Every competent therapist knows how to fill out an insurance form to get reimbused for seeing a person (or couple) who's in distress.
posted by DMelanogaster at 6:49 AM on February 11, 2023

Therapist here, who consults for other therapists on these issues.

Unless your insurance plan specifically says it covers couples counseling, using your insurance for couples counseling usually constitutes insurance fraud. Some therapists I know make a case for it being individual counseling for depression/anxiety for one person with the other partner there "in support of" the client. But that's treading a line I and many others are not comfortable doing, and is much harder to justify if you're there for "communications issues."

As for out of network reimbursement, I'm not sure what DMelanogaster is talking about; the majority of my clients have out of network coverage and many use it successfully. And if there is a *legit* diagnosis for *one person*, then you may be able to get reimbursed by your insurance company.

But again, insurance fraud.

So use Psychology Today to find a couples counselor who appeals to you and pay out of pocket.
posted by MonsieurBon at 7:04 AM on February 11, 2023 [1 favorite]

The online platforms you hear ads for on podcasts and whatnot are, as mentioned above, rent-seeking projects that treat the therapists like crap and have unethical privacy policies.

Unfortunately, in our current system, couples therapy is expensive. Therapists have to earn a living as well as pay for their own training, tools, health insurance, rent, etc.

If money is a big concern maybe seek out someone who mentions they have a more short-term, solution-focused approach?
posted by latkes at 5:50 PM on February 11, 2023 [1 favorite]