Academic journal article Journal of Marital and Family Therapy

The Case for Insurance Reimbursement of Couple Therapy

Academic journal article Journal of Marital and Family Therapy

The Case for Insurance Reimbursement of Couple Therapy

Article excerpt

Regardless of culture, country, or religion, the majority of individuals either marry, or enter into marriage-like cohabiting relationships (Weston, Qu, & Hayes, 2012). Throughout the world, over 85% of people marry by the age of 50 (United Nations Economic and Social Affairs Population Division, 2003). In fact, the yearning to be in a close, committed relationship is so universal that some consider it an evolutionary-driven urge (Buss, 2003).

Despite the prevalence of such committed relationships, many couples experience distress or relationship dissolution. In the United States, 31% of married couples are classified as being in a distressed relationship at any given time (Bradbury, Fincham, & Beach, 2000; Whisman, Snyder, & Beach, 2009), which is comparable to the rate of adult obesity (36.5%; Ogden, Carroll, Fryar, & Flegal, 2015) and is significantly higher than other behavioral problems, such as daily smoking (16.9%; Jamal et al., 2016) and alcohol abuse (6.8%; Center for Behavioral Health Statistics and Quality, 2015). This rate is concerning, considering that marital distress is typically considered to be an unremitting problem - one that fails to improve unless treatment is provided (Baucom, Hahlweg, & Kuschel, 2003) and a problem that carries with it a heavy burden of disease (Robles, Slatcher, Trombello, & McGinn, 2014).

Despite the prevalence and severity of marital distress, however, both government programs and insurance companies have failed to offer financial support for addressing it. Many health care providers explicitly state in their Evidence of Coverage (EOC) that couple therapy is excluded from their list of reimbursable procedures (e.g., CalPERS, 2016; Cigna, 2012; Government Employees Health Association, 2017; Medicare Consumer Guide, 2016; Tricare, 2016), while others specify that "treatment of a marital or family dysfunction" is a "noncovered treatment," and is "only covered when provided in connection with covered treatment for a Mental Disorder or Chemical Dependency" (Health Net, 2015, p. 54). While other health care insurers do not explicitly state that marital therapy is a noncovered treatment, the CPT code for marital therapy is not included on their list of reimbursable procedures (e.g., SelectHealth, personal communication).

Despite the unwillingness of insurance companies and government programs to pay for marital therapy, there is compelling empirical evidence to suggest that changing this long-held policy would be prudent. The high costs associated with marital distress can be reduced by couple therapy, which has been shown to be a cost-effective treatment for relationship problems. However, the cost of treatment, in the absence of financial support from insurance companies and government programs, is a substantial barrier for the dissemination of such services.


Marital distress is a significant risk factor for several outcomes that are costly to individuals and society. These include increased likelihood of divorce, poorer physical health, diminished psychological functioning, and lower work productivity.

Marital Distress and Divorce

Marital distress substantially increases the risk for divorce (Amato & Hohmann-Marriott, 2007). One study found that the probability of divorce for unhappily married women was almost three (2.92) times higher, compared to happily married women (James, 2015). These findings are of grave concern, considering the financial burden created by divorce, as well as the long-term mental and physical health outcomes that are often linked to it.

Divorce and health. Divorce is often associated with negative outcomes for physical and mental health, many of which are present up to a decade later (Sbarra, Law, & Portley, 2011). In terms of mental health, divorced individuals experience more anxious and depressive symptoms than their married counterparts (Amato, 2000; Hughes & Waite, 2009) and report more social isolation (Marks, 1996) - a factor that creates such a health risk that the magnitude of its effects is comparable to smoking, high blood pressure, obesity, and physical inactivity (Kiecolt-Glaser & Newton, 2001). …

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