Does Anthem Cover Couples Therapy?
How Anthem covers couples therapy — the diagnosis requirement, what qualifies as medically necessary, and workarounds when insurance does not apply.
The Short Answer
Anthem covers couples therapy conditionally. Like every major U.S. insurer, Anthem only reimburses couples therapy when at least one partner has a diagnosed mental health condition and joint sessions are part of that individual's clinical treatment plan. Pure relationship counseling, marriage enrichment, and premarital counseling are not reimbursable under Anthem or any other carrier.
When covered, sessions are billed as family psychotherapy (CPT 90847). Coverage is processed through Carelon Behavioral Health.
Key Takeaways
- Anthem covers couples therapy only when one partner has a diagnosed covered mental health condition.
- Sessions bill as CPT 90847 (family therapy with patient present).
- Pure relationship counseling without a diagnosis is not covered.
- In-network copays typically $20–$50 per session.
- If coverage doesn't apply, workarounds include EAP, HSA/FSA, sliding-scale providers, and individual therapy with occasional joint sessions.
What Anthem Covers for Couples Therapy
CPT codes
| CPT Code | Description |
|---|---|
| 90847 | Family therapy with the identified patient present |
| 90846 | Family therapy without the identified patient |
The "identified patient" — the one with the diagnosis — must be documented in the therapist's notes. The claim goes on their plan.
Covered scenarios
- A diagnosed partner whose recovery requires relational work (depression, anxiety, PTSD)
- A partner with substance use disorder doing joint work to support sobriety
- Trauma recovery where couples work is part of the diagnosed partner's treatment plan
Not covered
- Marriage enrichment / conflict resolution without a diagnosis
- Premarital counseling
- Relationship tune-ups between generally healthy partners
In-Network vs. Out-of-Network Couples Therapy
In-network
- Use Anthem Find Care; filter by Behavioral Health
- Call providers to confirm couples therapy specialty; credentials to look for: LMFT, Certified Gottman Therapist, Certified EFT Therapist
- Copay: $20–$50 per session
Out-of-network
- Cash-pay couples therapy: $150–$350 per session
- PPO plans reimburse 50–80% of allowed amount for 90847 after OON deductible
- HMO plans: no OON coverage
How to Verify Your Anthem Couples Therapy Coverage
Call 1-800-331-1476 or the BH number on your ID card.
Script
- "What is my copay for family therapy, CPT 90847?"
- "Is there a session limit for family therapy?"
- "Does 90847 require a specific diagnosis on one of us?"
- "If my partner has the diagnosis and a different insurer, can my Anthem plan still process a joint session?"
- "Do I have out-of-network benefits, and what is the allowed amount for 90847?"
- "Are telehealth couples sessions reimbursed at the same rate?"
Typical Out-of-Pocket Costs for Couples Therapy
For a 16-session course:
| Scenario | Per Session | 16-Session Course |
|---|---|---|
| In-network, $30 copay (diagnosis present) | $30 | $480 |
| In-network, $50 copay (diagnosis present) | $50 | $800 |
| In-network without a diagnosis (not covered) | Full fee | $2,400–$4,800 |
| OON PPO, 70% reimbursement | ~$70–$140 post-reimbursement | $2,200+ (year 1) |
| Cash pay | $150–$350 | $2,400–$5,600 |
See couples therapy cost for the private-pay view.
What to Do If Coverage Doesn't Apply
- EAP. Many Anthem employer plans include 3–6 free EAP sessions through Carelon — often usable for early-stage couples work without a diagnosis.
- HSA/FSA. Therapy is an eligible pre-tax expense, saving 20–35%.
- Sliding-scale providers. Open Path Collective connects clients to couples therapists with income-based rates.
- Individual + joint. Each partner in individual therapy (covered under their own plan), with occasional joint sessions hosted by one of the therapists.
What to Do If Anthem Denies a Couples Therapy Claim
- Get the EOB in writing.
- Ask your provider to peer-review with Carelon.
- File a first-level appeal within 180 days.
- Cite MHPAEA parity if comparable family-based medical treatments are covered.
Frequently Asked Questions
Does Anthem cover Gottman Method or EFT specifically? Neither has its own CPT code — both are billed as 90847. Coverage depends on the diagnostic frame.
Does Anthem cover premarital counseling? No — not a covered medical service on any Anthem plan.
Does Anthem cover online couples therapy? Yes, when correctly billed under 90847. Telehealth parity applies.
Can we both use our Anthem plans for the same session? No — only one plan can be billed per session, and the claim goes on the diagnosed partner's plan.