Is Sex Therapy Covered by Insurance?

Sex therapy is increasingly recognized as a valuable tool for enhancing sexual well-being, both individually and within relationships.

From addressing specific concerns like arousal issues or sexual pain to helping couples improve intimacy, sex therapy can positively transform how clients experience their sex lives.

However, many people wonder whether health insurance can help make this specialized therapy more affordable.

While some insurance plans provide coverage, it varies widely depending on the specific insurer, plan type, and even the way services are billed.

Understanding insurance coverage for sex therapy

Health insurance companies usually categorize sex therapy as a mental health service, which opens up potential coverage for clients.

This means that if your plan includes mental health benefits, there's a possibility that it will also cover sessions with a certified sex therapist.

To get more insight, I spoke with Camille Espinoza, an AASECT-certified sex therapist. She said that "Insurance coverage for sex therapy is usually the same coverage for any other psychotherapy that's included in your plan."

Sex therapy is just like any other talk therapy. The only difference is that you're talking about feelings and experiences about sex and intimacy.

Espinoza continues, "Just like any other therapy service, your provider will issue a diagnosis that goes in your medical record, and to the insurance company."

However, certain conditions must be met before coverage kicks in.

Insurance companies often need to confirm that the service is "medically necessary" for it to qualify for coverage.

This generally means having a relevant diagnosis, such as Erectile Dysfunction or Female Orgasmic Disorder, that justifies the need for sex therapy.

Since mental health diagnoses are frequently needed to meet this standard, it's crucial to understand which conditions may apply and how a diagnosis might influence the coverage process.

When sex therapy is likely to be covered

Coverage for sex therapy is more likely under certain circumstances. Here's what most insurers look for:

• Licensed Mental Health Provider Requirement: For insurance to cover sex therapy, the sessions typically must be conducted by a licensed and credentialed mental health professional. This could include a licensed counselor, psychologist, or social worker with specialized training in sex therapy.
• Common Diagnoses for Coverage: Insurance companies often require a specific diagnosis to approve payment. Common diagnoses that might qualify include sexual dysfunction, intimacy disorders, and other conditions related to either. These diagnoses establish a "medical necessity" for the therapy, making it more likely to qualify for coverage.
• Necessary Diagnostic and Procedure Codes: Sex therapists must submit claims with accepted diagnostic and procedure codes that align with your insurance plan's requirements. Codes related to mental health or medical conditions linked to sexual health concerns (such as female orgasmic disorder or delayed ejaculation) are often needed for insurance approval.

This covers the very basics of coverage for sex therapy. But is a diagnosis necessary?

Do you need a diagnosis?

In most cases, insurance providers require a diagnosis to verify that sex therapy meets the "medical necessity" criterion for coverage.

This means that your therapist will need to document a specific mental health or medical condition related to your treatment.

Examples of Billable Diagnoses: Diagnoses that commonly qualify for insurance coverage include conditions like:

• Sexual Dysfunction (e.g., erectile dysfunction, anorgasmia, or delayed ejaculation)
• Intimacy Disorder (often related to stress or trauma impacting intimacy)
• Mental Health Diagnoses (such as depressive disorder or post-traumatic stress disorder)

While a diagnosis can help get your therapy sessions covered by insurance, it's worth noting that some clients prefer to avoid having a formal diagnosis recorded due to privacy or personal concerns.

Discussing these factors with your therapist can help clarify what's best for you and your goals in therapy.

Steps to verify coverage with your insurance

If you're interested in exploring insurance coverage for sex therapy, following these steps can help clarify your options:

• Step 1: Call your insurance provider and ask about coverage specifically for "sex therapy" or "psychosexual counseling" under outpatient mental health benefits. Ask if they have any specific limitations on visits or restrictions on diagnoses they cover.
• Step 2: Check your network. If you're aiming to minimize costs, search for in-network providers who specialize in sex therapy. Since few insurance networks specifically list certified sex therapists, you may need to verify whether a general mental health professional with relevant experience qualifies.
• Step 3: Request coded invoices. If your provider is out-of-network, ask if they can bill your therapy sessions using covered diagnostic and procedure codes. This can make a significant difference in helping your insurer process claims for reimbursement. (And if they provide the documentation, you can let Thrizer manage your claim for just $2.)
• Step 4: Appeal any denials. If your insurance company denies a claim, don't hesitate to appeal the decision. Sometimes, denials are made due to coding errors or misunderstandings of medical necessity. An appeal can help clarify the need for treatment, especially if it's linked to a documented mental health condition.

Working with insurance companies can help you afford sex therapy. Remember to be persistent in seeking access to your plan's benefits.

What if my insurance doesn't cover sex therapy?

If your insurance doesn't cover sex therapy, there are still several options to consider to make therapy affordable:

• Out-of-Pocket Costs: Even if insurance won't pitch in, you can still go to therapy. You'll have to pay out-of-pocket, meaning you foot the entire bill. Private pay rates for sex therapy vary widely but generally fall between $50 and $200 per session depending on the provider's location, credentials, and experience.
• Alternative Payment Options: You may be able to use Health Savings Accounts (HSA) or Flexible Spending Accounts (FSA) to pay for sex therapy. These accounts allow you to use pre-tax dollars for mental health expenses, including sessions with a certified sex therapist.
• Superbills for Out-of-Network Reimbursement: Many sex therapists who don't accept insurance directly will provide a superbill—an itemized receipt of services. You can submit this to your insurance provider for potential out-of-network reimbursement, though you may still be responsible for a higher deductible or co-pay.

Alternatively, you can let Thrizer submit your superbill for you. You can be confident that things were done right and all you have to do is focus on therapy.

Making sense of your benefits

Navigating health insurance can feel overwhelming, especially when it comes to specialized services like sex therapy. Here are a few additional tips to help you get the most out of your benefits:

• Talk to Your Insurance Provider: Always check directly with your insurer for the most accurate information about your coverage. Ask specific questions about sex therapy, psychosexual counseling, or related mental health services and whether certain diagnoses will qualify for coverage.
• Ask the Right Questions: When speaking with your insurer, ask about annual limits on therapy sessions, deductible amounts, and if they have a separate "out-of-network" benefit that could partially reimburse you for sessions.
• Discuss Coding Procedures with Your Provider: If you're working with an out-of-network provider, they may still be able to help you navigate billing. Discuss diagnostic and procedure codes they could use to potentially qualify for insurance reimbursement. Addressing these logistics up front can make the claims process smoother.
• Prepare for Potential Roadblocks: Insurance companies may deny claims for sex therapy due to coding issues or definitions of medical necessity. If this happens, reach out to both your therapist and insurance company to discuss options for filing an appeal.

Your benefits are yours, but it may take some work to access them. Stay consistent and you'll be more likely to get the help you need.

The taboo is lifting: accessing sex therapy

As cultural views on sexual health continue to evolve, more people are embracing therapy to address intimate issues.

Espinoza, whom we heard from earlier, tells us why.

"First, therapy in general is less stigmatized than just a decade ago, so a lot of people are already in therapy."

When people are already in therapy, working with a specialist like a sex or couples therapist feels more natural.

It's also normal to know a friend or two who are seeing therapists themselves.

"Secondly," Espinoza points out, "there is an abundance of information on social media, podcasts, and TV about sexuality, so people are looking for support around that."

Espinoza notes that talking about sexuality is becoming normalized among friends. So it's a natural step to want to talk with an expert, too.

Many are finding that sex therapy can provide tools to address concerns like sexual dissatisfaction, intimacy struggles, and relationship conflicts, paving the way for healthier sexual and emotional lives.

Although insurance coverage for sex therapy may be either simple or complicated, it's increasingly recognized as a valid form of mental health treatment.

Working proactively to understand your benefits and discussing options with your provider can open doors to the care you need.

Sex therapy coverage, summarized

Sex therapy can be a transformative experience, whether you're working through specific challenges or striving for a more fulfilling sex life.

While insurance coverage is possible, it often depends on finding a compatible provider, meeting diagnostic requirements, and following a few steps to verify your benefits.

If insurance barriers prevent you from seeing a sex therapist, remember that many offer alternative payment options and out-of-network reimbursement assistance.

By exploring these options and asking the right questions, you can find ways to make sex therapy accessible, helping you achieve the intimate, healthy relationships you deserve.

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This blog post is provided for informational purposes only and is not intended as legal, business, medical, or insurance advice. Laws relating to health insurance and coverage are complex, and their application can vary widely depending on individual circumstances and state laws. Similarly, decisions regarding mental health care should be made with the guidance of qualified health care providers. We strongly recommend consulting with a qualified attorney or legal advisor, insurance representative, and/or medical professional to discuss your specific situation and how the laws apply to you or your situation.