Sexual health is an important component of overall wellbeing.
However, many people experience challenges in their sex lives that can negatively impact relationships, self-esteem, and quality of life.
Sex therapy aims to help individuals and couples overcome these issues. But a common question is – does insurance cover the cost of sex therapy?
What is Sex Therapy?
Sex therapy is a specialized form of talk therapy provided by licensed mental health professionals known as sex therapists. The focus is helping people address sexual difficulties like:
- Low sexual desire
- Pain during sex (dyspareunia)
- Inability to orgasm (anorgasmia)
- Early ejaculation
- Compulsive sexual behavior
- Intimacy issues
- Sexual trauma
Sex therapists use techniques like cognitive behavioral therapy (CBT) to help clients improve sexual self-esteem, communication, performance, and satisfaction.
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Common Questions About Insurance Coverage
Many clients wonder:
“Will my health insurance plan cover sex therapy sessions?”
Coverage varies greatly by plan. Most insurers view sex therapy as a mental health service and cover it the same as regular psychotherapy. Typically, large employer-provided policies offer the best benefits.
“Do I need a diagnosis for insurance to pay for sex therapy?”
In many cases, yes. Insurance plans often require a diagnosed mental health or medical condition to qualify services as medically necessary and covered.
Common diagnoses include sexual dysfunction, intimacy disorder, depressive disorder, and post-traumatic stress disorder (PTSD).
“What is the typical cost if my plan doesn’t cover sex therapy?”
Out-of-pocket rates range widely from $50-$200+ per session based on the provider’s credentials and location. Sessions usually last 45-60 minutes and average 12-20 visits.
Here are some tips for understanding sex therapy coverage under your health insurance:
1. Call your insurance company. Verify if your plan covers “sex therapy” or “psychosexual counseling” as an outpatient mental health treatment. Ask about visit limits.
2. Check if your provider is in-network. Search for an in-network sex therapist to minimize costs. Confirm they can bill services appropriately.
3. Get coded invoices. Ask to have each bill coded with a covered diagnostic and procedure code. This facilitates proper filing and claim processing.
4. Appeal claim denials. If your insurer declines payment, appeal the decision if there’s reason to believe services qualify as “medically necessary care.”
| Type of Plan | Typical Coverage |
|---|---|
| Medicaid | Covered |
| Medicare | Not covered |
| Large Group Plans | Covered if medically necessary |
| Small Business / Individual Plans | Not covered usually |
When Sex Therapy May Be Covered
In many cases, insurers will cover sex therapy if:
- Provided by a properly licensed mental health professional
- Deemed medically necessary treatment
- Supported by a diagnosed physical or mental health condition
- Billed under acceptable diagnostic and procedure codes
By taking the right steps to document medical need and network status, many clients can get coverage for issues like sexual pain, erectile dysfunction, vaginismus, and more.
Checking Your Specific Benefits
Navigating health insurance can be complicated.
To determine your specific coverage details for sex therapy or similar services, always check directly with your insurance plan or the Healthcare Marketplace.
Contact a prospective provider to discuss medical coding procedures as well. Addressing these considerations proactively makes accessing care easier.
The taboo around sex difficulty is lifting, and help is increasingly available. Sex therapy gives the tools to unlock a happier, healthier sex life – and insurance coverage can aid affordability.
With some diligence about plan specifics, many can get their treatment costs covered.
Erica Barnes, Sr. Researcher
Great article on understanding insurance coverage for sex therapy. It’s helpful to know what options are available for those seeking professional support. This information can make a big difference in accessibility for many.
We live in Osceola County, Florida and have CAREPLUS INSURANCE. PHONE NUMBER IS 407-xxx-xxxx. CAN YOU PLEASE CALL US?
Hi Patricia, thank you for leaving us a comment. Best way for you to connect with a specialist would be to call your primary care provider through your insurance and request a referral to a specialist. If you still need our assistance, please don’t hesitate to send us an email at support@therapyhelpers.com
Have a great day!