Is Sex Therapy Covered by Insurance?

You may be wondering, “does health insurance cover sex therapy?” The short answer is, it depends.

In this post, I will discuss when sex therapy is covered by insurance and why I do not accept health insurance as a sex therapist. The reasons may surprise you…

Can I use my health insurance for sex therapy?

Using health insurance for sex therapy could be a money saver, but is it too good to be true? In short, probably. Between diagnoses, privacy concerns, and insurance loopholes there are many reasons why I do not accept health insurance for sex therapy. In this blog post, I will cover possible ways to use health insurance for sex therapy. I will also cover the reasons why I do not accept health insurance for sex therapy. In short, I’m not willing to compromise your privacy or pathologize what you’ve got going on. Let’s get into it.

Does my health insurance cover sex therapy?

Generally speaking, yes. If your health insurance plan has mental health coverage and your therapist is in network with them, then you may be able to use your health insurance to cover sex therapy.

It is understandable to want to take full advantage of your (probably very expensive) health insurance plan. Having a copay for a session and letting your insurance foot the rest of the bill almost sounds awesome! But is it too good to be true? Probably.

Diagnosis Dilemma

In order for health insurance to cover sex therapy, your therapist must provide a diagnosis to the insurance company. Insurance companies require a diagnosed illness for billing purposes. They call this “medical necessity.”

There are diagnoses relevant to sex therapy. For example, Female Orgasmic Disorder or Delayed Ejaculation are diagnoses deemed worthy of treatment by most major insurance carriers. If the insurance company accepts the diagnosis, you’ve made it past the initial request! But, yes, you guessed it, the insurance company will only accept the initial diagnosis for so long.

Therapists accepting insurance for sex therapy must consistently prove to the insurance company that what you are seeking treatment for is medically necessary. This means that you and I could decide that your therapeutic needs require more intervention, but the insurance company can say “no.” If your insurance company decides you don’t “need” the treatment or it is no longer deemed “medically necessary” they can stop paying.

I’m not willing to take that kind of risk with your mental health and well-being.

Reasons I do not accept health insurance for sex therapy

Privacy Concerns

When a therapist accepts health insurance for sex therapy (or any therapy really), they are required to provide details about you and your care. For each billable service, a therapist must provide the following:

• Your identifying information

• A diagnosis

• Date and length of session

• A summary of treatment provided during the session

Additionally, insurance claims are processed by multiple people. This means that multiple people could find out that you are struggling with a sexual dysfunction or disorder. It’s difficult enough to reach out for support for something sex related, you don’t need anyone else knowing your business. And you definitely don’t need insurance adjusters making decisions about your therapeutic needs.

In short, I do not accept health insurance for sex therapy because your privacy is important to me. I do not accept health insurance for sex therapy because I am not willing to allow an insurance adjuster to decide whether or not you need more care. I will be the judge of that, thank you very much (with your input, of course).

Diagnosis Concerns

You’ve already read about the diagnosis dilemma outlined above, but I will recap it here:

In order for your health insurance to cover sex therapy you need to be diagnosed with an illness. Your therapist then has to prove over and over again that you require “medically necessary” treatment for said illness.

Pre-existing Condition Concerns

In addition to insurance companies wanting to decide how long your treatment is “necessary” based on a diagnosis, they can also use that diagnosis against you in the future.

All diagnoses become part of your medical record and could be considered pre-existing conditions down the road. Pre-existing conditions can have a significant impact on your ability to secure health insurance coverage in the future. Even if you are able to secure coverage in the future, a pre-existing condition can be grounds for higher premiums, deductibles, and/or copays.

I do not accept insurance for sex therapy because I am not willing to put you at risk for a “pre-existing condition” that may cause problems for you in the future. Because let’s face it, whatever brings you to sex therapy is probably not an *actual* condition.

What can you do to help me get the most out of my health insurance coverage for sex therapy?

Until I trust that the insurance companies I might contract with in the future are safeguarding your mental health and allowing us to do the work we need to do, I won’t be accepting insurance for sex therapy.

Chelsea, you’re killing me….

I know.

It’s frustrating to pay so much money for health insurance and not be able to use it to cover the things you actually need.

Here’s the good news!

By not accepting health insurance for sex therapy I can:

• Give every single client the personalized attention they deserve

• Not pathologize your sexual behavior or concerns

• Spend time increasing my knowledge and skills to serve you, rather than fighting insurance companies

• Place my focus on client care, not medical billing

Working with a burnt out therapist is not going to help you. By not accepting insurance I am able to focus on the things that make me a great therapist, and that’s important for both of us.

Superbills

While being an out-of-network provider for all insurance plans means that I do not work directly with your insurance company, I can provide you with a superbill. A superbill is a document of professional services provided (like a receipt) which you can submit to your insurance provider for potential out-of-network reimbursement.

Fair warning about superbills and out-of-network reimbursement:

• HMO plans generally do not provide out-of-network coverage

• If you have a high deductible, you will need to meet it before you are eligible to receive reimbursement

• A superbill is not a guarantee of reimbursement from your insurance provider

If you want to try to use some of your insurance benefits for my services, the best thing you can do is call your health insurance company and ask about reimbursement for outpatient mental health services with out-of-network therapists.

What are my options for working with you as a sex therapist?

While I do not accept any form of insurance for sex therapy here are ways we can work together:

• I accept all major credit cards for services

• I accept Flexible Spending Account (FSA) and Health Savings Account (HSA) cards for services

• I can provide a superbill to you upon request

I hope that spending some time explaining why I do not take insurance right now was helpful and informative. If you have any questions about it, please feel free to email or call me with further questions.

If you think you may be ready to take the leap into therapy with me, I would love to hear from you!

If you live outside Colorado, unfortunately, I can’t be your therapist, but there is someone else who can be! 

The American Association for Sexuality Educators, Counselors, and Therapists (AASECT) is a great place to start when looking for a provider. Using AASECT’s “find a professional” link will bring you to a directory of qualified sex therapists. 

Other ways to find a sex therapist include:

• Getting a referral from a healthcare professional

• Asking your health insurance company for a list of mental health professionals who specialize in sexual health

• Contacting your local LGBTQ Center for resources around mental health or sex positive therapists. In Colorado, it’s The Center on Colfax.