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Recently, after giving a talk at a local Polyamory Lecture Series, I was chatting with some of the attendees. They asked me what it would look like for their polycule (a group of people connected by their relationships, usually romantic and/or sexual, to one or more members of the polyamorous group) to treatment.
They shared that the two of them were under the same insurance plan, but they had another spouse they wanted to bring with them for treatment and they weren’t sure. how that works. Insurance questions are some of the most difficult to answer as a doctor, especially when working with couples and families, because the issues are so varied.
Under the US insurance model, there is no coverage for any married, related or family members, regardless of which insurance provider you have. Some therapists will choose to work within the system by taking a couple, giving one of the clients an individualized assessment such as anxiety or depression, and then using a second assessment for relationship problems. . But if the doctor uses a diagnosis of relationship problems, which many couples will, medical insurance will generally deny the claim and tell consumers to pay out of pocket.
Medical insurance is based on the model of individual health care, and it is rarely acknowledged that problems can be systemic and occur between people. This is the biggest obstacle I see for insurance providers that cover relationship and family therapy.
As a Licensed Marriage and Family Practitioner, I am trained in management theory. This is the idea that you can treat systems and not just individuals from a therapeutic perspective. What does that mean for treatment? It means that I can see couples, relationships and families of any kind and I am trained to handle many people’s emotions, problems and feelings in one room. We learn to help people whose reason for coming to therapy may not be because of an individual diagnosis or challenge but because they have a relationship problem.
When I was in graduate school, we rarely talked about insurance issues and how it works in an audit. Generally, therapists only learn about the billing aspects of treatment once we are out of school and employed in mental health or group settings. I had to learn the ins and outs of insurance myself through continuous hours of education, care, reading articles and talking to other doctors about their experiences.
Most therapists who see couples, relationships, families or individuals for sex therapy will not attempt to take insurance and will take clients who pay out of pocket. This is easy because you get paid right away and you don’t have to deal with insurance claims rejection or hiding the money they paid because the test didn’t match their needs. This confuses many consumers who wonder why their medical insurance does not cover mental health.
The lack of mental health providers in Washington makes it even more difficult to get care. The 2018 Washington State Health Survey found that there is only one mental health provider for every 360 people in Washington.
Most of the psychologists surveyed by the American Psychological Association said that since the beginning of this epidemic, they have seen an increase in patients dealing with anxiety, stress and depression. About half of doctors said they have seen an increase in patients with substance abuse problems.
There have been other changes to improve access to mental health care: For example, in May 2023, Washington state dropped its previous requirement that marriage and family therapists work for years two after graduation in order to allow most doctors to fully recover. license quickly.
The US also recognizes Marriage and Family Therapists and Mental Health Counselors as Medicare-eligible treatment providers. This should increase the number of providers available to see family psychotherapy and multi-family group clients, and it will actually be covered by insurance for the first time. This is a good step, but I would like to see a larger treatment process under Medicaid as well, where people are limited to a list of available specialists.
Sometimes, the obstacle is not only the number of professionals available, but also the right ones for certain customers. This can be especially difficult if the client is LGBTQIA+, polyamorous or any other marginalized identity and is looking for a doctor who validates their identity and knows their issues well without being covered by their insurance. Unfortunately, many times potential clients tell me that they feel like they have to choose between a doctor who is covered by their insurance and a doctor who is right for them but requires an out-of-pocket payment.
There are three main things I would like to see improved in the future. First, I would like to see medical insurance providers provide clear information on how to get treatment as well as come to terms with the fact that they are currently paying for individual health care.
Second, I would like to see all medical insurance providers expand their health definitions to cover family and couples/relationship therapy to supplement individual coverage.
Finally, I would like to see other methods of access to specialists for people in disadvantaged communities who do not want to choose between a doctor covered by insurance and a specialist who understands their life experience.
These are major system changes that will require advocacy, time and a lot of people to get on board. You never know when you might need treatment. If you and other people you care about want the option of going to marriage, couple and family counseling one day, you can advocate for these types of counseling to be covered by your insurance.
Camille A. Saunders is a Licensed Marriage and Family Therapist who received her Master of Arts degree in 2021 from Pacific Lutheran University. She practices privately at Camille A. Saunders Therapy Services, where she works with clients throughout Washington state from her office in Sumner. Saunders supports individuals and their partners struggling with anxiety, chronic pain and illness, relationship issues, self-esteem and sexuality.
