Starting May 1, 2022 I will no longer be accepting insurance for sex and couple’s therapy.
Why the change?
This change has been in the planning stage for months with great consideration given to the impact of providing these essential therapy services to the community. The primary factor that influenced my decision is managed care and the changes that have occurred over time in their reimbursement rates and policies. The bottom line is insurance companies do not pay for sex therapy or couple’s therapy.
Do you know what you are really agreeing to when you enroll for health insurance either through your employer or through a health connector? Have you read the small print?
Mental health benefits are only reimbursed under your health insurance policy for individuals with a diagnosed mental illness. The concerns/issues that bring couples to therapy, such as communication issues or relationship conflict, or for sexual issues such as lack of sexual desire, and sexual dysfunction are not diagnosable mental health conditions.
All medical and mental health benefits are only covered if the services meet “medical necessity” requirements. Consult your health plans definition of medical necessity for more information.
Insurance companies have always engaged in the practice of conducting audits of psychotherapy records (yes, they can read your psychotherapy notes!). If the therapist’s documentation doesn’t meet their standards (medical necessity), they can require the therapist to pay back the insurance company for services they previously covered and paid. This is a practice that is not widely known or publicized.
My Bottom Line…
I want to provide my clients with quality care and address the concerns that bring them to treatment without the restrictions imposed by insurance companies.
After working with couples for many years, I have learned that the 50-minute session isn’t an adequate amount of time to address complex issues that couples bring to treatment. I will now be providing 80-minute couples sessions where more can be accomplished, and you can feel greater satisfaction with your progress in treatment.
My fees will be restructured as follows:
Diagnostic Evaluation $145.00
Individual Psychotherapy: 50-minute sessions $135.00
Couples Psychotherapy: 50-minute sessions $155.00, 80-minute sessions $175.00
As the sole owner of Couples Counseling of Amherst, I’ve had to consider how I want to best spend my time providing quality care to my clients. This has been a difficult decision to make, and I hope as we all become more aware and informed of how our health and mental health benefits are managed, we can be more empowered to take back control of our ability to make decisions about our mental health care, unencumbered by third parties, and maintain the confidentiality and privacy we all demand.
Marlene Meinelt LICSW, CST