Out of Network Therapy Services
Learn more about the most frequently asked question:
Why doesn’t Sage & Shadows Counseling take insurance for couples/relationship therapy?
Insurance was built around individuals. It was structured for illness-based treatment, not the shared complexity of two (or more) people trying to heal a relationship together.
To use insurance for couples/relationship therapy, I would have to name ONE partner as the “identified client” and assign a mental health diagnosis, often to the person whose policy we are using. That diagnosis must be justified session after session, sometimes pulling attention toward symptoms instead of the relational dynamic while the other partner becomes secondary in a space that is meant to hold all of you. We would also be limited by session caps and required to share sensitive information with the insurance company.
That structure does not reflect best practice in couples/relationship therapy.
Working privately allows us to focus on the relationship itself, to decide together how long and how often we meet, and to honor both partners without placing an unnecessary diagnosis on either one.
I believe in making therapy accessible while keeping the therapeutic space to me and my client(s). To make this possible, I have partnered with Thrizer, a payment application that handles the out-of-network benefits process for you. First, we will confirm your insurance provides out-of-network benefits. If so, I will use Thrizer to charge for our sessions to make sure you only pay your out-of-network responsibility. Using out-of-network benefits may put your care at risk of being reviewed by insurance and requires a diagnosis that becomes a part of your permanent healthcare record.
Benefits of self pay
Ethical scope & flexibility
Self pay shifts the focus back where it belongs. We treat the relationship itself, not just one person carrying the weight of a diagnosis.
It allows us to extend sessions when depth is needed, to slow down when something tender surfaces, and to shape our work around your shared goals rather than around billing codes or external limits. We can hold both of you fully, without narrowing the story to fit a medical model.
Regulatory simplicity
Self pay keeps the process simple, with clearly stated fees and straightforward payment expectations, without the delays and administrative back-and-forth that often come with insurance billing. There are fewer forms, fewer approvals, and fewer outside systems involved in your care.
Less administrative work means more presence. More attention for you and your partner. More space to do the work that actually matters.
Get the care you deserve on your terms.
Barriers to in-network couples/ relationship therapy
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Insurance reimburses treatment when there is a diagnosable mental health disorder; relationship distress alone is rarely considered enough despite having a clear need. This means intimate relationships can show up motivated and hurting, yet still receive little to no covered sessions
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To access benefits, one partner must carry a diagnosis and be labeled the “identified patient.” Sessions are then categorized as family therapy with “the patient present.”
This structure subtly shifts the focus onto one person’s symptoms, which can reinforce blame and imbalance in a space meant to support shared responsibility and growth. It also leaves a mental health diagnosis on that partner’s permanent medical record, even when the true focus is relational repair. One person becomes the problem. The relationship disappears from view.
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The DSM-5 and ICD-10 recognize “other conditions that may be a focus of clinical attention,” including relational concerns. Yet most insurance plans reimburse only individual mental health disorders.
Clinicians are often left choosing between assigning a diagnosis that does not fully fit or risking claim denial. When claims are denied, intimate relationships can be caught in the middle, facing unexpected bills and frustration with a system that does not reflect their lived experience.
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Relationship work requires time to slow down patterns, regulate nervous systems, and allow all partners to be heard. Evidence-based relationship therapy models frequently recommend 75- to 90-minute sessions, co-therapy formats, or even multi-hour intensives. Standard insurance benefits typically cover one 50-minute session. That structure can interrupt momentum and limit depth in a way that does not align with best practice.
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Relationship therapy is commonly denied as “not medically necessary.” This creates a cycle of prior authorizations, appeals, and audits. Time that could be spent preparing for your session or reflecting on your progress is instead directed toward paperwork and defense of care. It pulls energy away from the therapy room and toward the insurer.
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During audits, insurers may request detailed treatment notes. This can include deeply personal information such as sexual history, relational conflicts, or trauma disclosures. Some partners are not comfortable with intimate details being stored in insurance databases or accessible through employer-linked plans. Privacy becomes another consideration in deciding how to pursue care.