Hello, Representative. Does My Insurance Cover Sex Therapy?
Last updated: May 2023
As I explained in a previous post, about a year ago my sex life was really suffering – partly as the result of having two very young children but also due to the physical and emotional impact of living with a chronic illness like rheumatoid arthritis. So, after visiting my doctor to have my hormones checked and utilizing all the resources I could find on my own, I made the decision to talk to a sex therapist.
Chronic Illness and Sexuality
Finding a therapist was relatively easy. I happened to know there was a local therapy practice that focused on intimacy issues because I had seen the founding therapist speak at a support group for parents. I emailed the practice and asked to be paired with the therapist who had the most experience dealing with the impact of chronic illness on sexuality. The therapist they paired me with mostly had experience with cancer recovery – conditions you can actually recover from rather than chronic lifelong conditions – but I thought it would give him enough background to start to understand the issues I was facing. So I made an appointment. (If you would be interested in speaking to a sex therapist but don’t quite know where to start, the American Association of Sexuality Educators, Counselors and Therapists (AASECT) has a database you can search by geographic location!)
Sex Therapy and Insurance
Figuring out if my insurance would pay for the counseling – and, if so, how much – was another story altogether. My husband and I started by reading through our insurance coverage information on counseling services. The PDF we were looking at listed some things that were specifically excluded, but it didn’t specify what was included. So we went to our provider’s online chat feature to try to determine whether seeing a licensed sex therapist would be covered.
It was a convoluted and, to be honest, rather uncomfortable conversation. First, the representative told us that the only real exclusions were services that were not personally directed – such as group therapy or family therapy. So then we asked if a covered individual (me) seeing a licensed sex therapist would be covered. At that point, the representative asked us to clarify whether it was an addiction type service or more for problems with the actual mechanics of sex, which is a lot more personal than I really wanted to be getting with a random stranger in an online chat! Eventually, the representative was able to tell us that counseling would be covered so long as it wasn’t related to sexual dysfunction – but she wasn’t able to define what qualified as sexual dysfunction.
At that point, I turned to my therapist’s office to ask for advice. They told me, despite the fact that they were licensed sex therapists, the codes they would use to bill my appointments would be no different from seeing an ordinary therapist for mental health. So, as far as my insurance was concerned, there wasn’t going to be any mention of sex – and I would be covered under my mental health services.
But, of course, the therapist I wanted to see wasn’t in the network. So then I had to go back to my insurance company to figure out how much would be covered. My insurance company told me that out of network therapy services would be covered at 60%. However, it wouldn’t be 60% of what the therapist actually charged me – it would be 60% of the “allowed amount,” which was apparently determined by average rates based on the geographic location where the services are rendered. But, despite my insistent questioning, the representative was unable to tell me what my “allowed amount” would be nor could she point me to anyone who could.
This meant that the only way to go forward was to go see the therapist, pay $150 out of pocket, and then submit my receipts and hopefully be reimbursed for as much of it as possible. Of course, since it took my insurance almost a month to process the first receipt, I saw the therapist several times before I found out how much would be covered. In the end, the “allowed amount” was only $79, so I was reimbursed $47.40 for each session. This left me paying over $100 out of pocket for each visit.
You might wonder why I’m sharing the boring nitty gritty of the insurance mess I had to deal with in order to talk to a sex therapist. I’m sharing because being able to speak to a sex therapist had an overwhelmingly positive impact on my relationship and my life. We didn’t just talk about sex - the therapist helped me deal with some of the emotional impacts of life with RA that I didn’t even realize had been holding me back. He helped me find practical ways to work on self-care, to focus on enjoying my life, and to find the energy to care for my husband and family. Deciding to speak to a sex therapist was one of the best decisions I’ve ever made towards improving my quality of life.
So I’m sharing the insurance nitty gritty because, despite the overwhelmingly positive impact these appointments had on my overall health, my insurance didn’t cover much of it and the portion they did cover was a big hassle to get reimbursed for. I was only able to take advantage of this important mental health service because I had the luxury of being able to pay the majority of it out of pocket. And I think that’s a real problem. Sexual health and mental health are an important quality of life issue for everyone, and I don’t think there should be so many hurdles and roadblocks involved in trying to get help.
Did you know rheumatologist Dr. Donica Baker is answering community questions?
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