Couples Therapy
And Insurance

An Investment in Your Relationship

Choosing couples and marriage counseling is a profound step toward a healthier, more fulfilling relationship. I am here to provide the highest level of care without compromise.

Couples counseling is not covered by health insurance as it's not considered a medically necessary service and I would argue that being in an unhealthy or dysfunctional relationship can result in severe mental health challenges and it absolutely needing to be medically necessary.  Check out this article for more information on how relationship challenges impact mental and physical health.

Not all Therapists are Couples Therapists

Couples counseling can be demanding work and requires a unique skill set. Most couples therapists who accept insurance for couples therapy are not trained in couples therapy which makes it quite difficult to get the results you want. The result is that change sometimes doesn’t happen or takes longer, the therapist tries to teach you relationship skills to the parts of you that cannot and will not use them. The end result is the partners give up because they are frustrated because they don’t see change because weekly, 50 minute sessions are not therapeutic enough to do the work.

I am trained in Relational Life Therapy and pursuing my certification which is a 2 year intensive program and hundreds of hours of couples therapy sessions and will be receiving my certification this summer 2026.
Couples therapists must protect both parties’ well-being, continually check their biases, and draw upon complex research in numerous fields. Health Insurance companies are notorious for limiting and curtailing the length and type of counseling clients deserve, which impacts the caliber of care a couples therapist can provide you.

In the past my clients have gotten frustrated with the insurance limits of weekly, 50 minute sessions. “Richie, by the time we get to some core issues, the session is up and it is frustrating to have to leave when we feel like we are just getting started”. Using insurance in couples work drags the healing process on and couples become frustrated “It is taking too long”. Therefore, I only offer 90 minute couples counseling sessions. I also offer couples intensives for busy couples or couples in crisis and are trying to figure out if they want to stay in the relationship.

When you work with a trained couples therapist. The process is more effective, efficient that creates faster change that lasts which means you are out of therapy sooner so you can get back to living your life not spending hours, months and years in an therapy office.

Why I Don’t Take Insurance for Couples Therapy

The Honest Answer Most Therapists Don’t Explain

If you’ve been searching for couples therapy, you’ve probably asked:

“Why doesn’t insurance cover this?”

It’s a fair question—and you deserve a clear, honest answer.

The reality is this:

Insurance is designed to treat individuals with mental health diagnoses—not relationships.

And that creates a major problem when it comes to doing real, effective couples work.

Couples Therapy Isn’t Built Around a Diagnosis

Insurance companies require:

  • A mental health diagnosis

  • A medically necessary treatment plan

  • An identified patient

But in couples counseling, the focus isn’t one person.

The focus is the relationship itself.

Most couples come in saying things like:

  • “We keep having the same fight over and over”

  • “We feel like roommates”

  • “We love each other but can’t connect”

  • “We don’t feel heard, respected, or understood”

These are real problems—but they are not medical diagnoses.

So in order to bill insurance, a therapist would have to:

  • Label one partner as “the problem”

  • Assign a diagnosis (even if it’s not accurate)

  • Frame the work as treating that individual—not the relationship

That’s not how I work.

I Refuse to Pathologize One Partner to Treat a Two-Person Problem

In many insurance-based models, one partner becomes:

  • The “identified patient”

  • The one who is seen as needing treatment

But most relationship issues are systemic:

  • Patterns of communication

  • Emotional reactivity

  • Power struggles

  • Unresolved past wounds (what we call the Adaptive Child in Relational Life Therapy)

Blaming one person distorts the work—and often makes things worse.

Instead, I help both partners:

  • Understand their role in the dynamic

  • Take accountability

  • Build new patterns of connection

That requires a different approach than insurance allows.

Real Couples Work Requires Freedom—Not Insurance Restrictions

Insurance companies place limits on:

  • The length and frequency of sessions

  • The type of treatment provided

  • The goals of therapy (must be symptom-based)

But meaningful couples work often requires:

  • Deeper, longer sessions

  • Honest, direct conversations

  • A structured approach that addresses both partners equally

My work—especially using Relational Life Therapy (RLT) and my R.E.L.A.T.E. Method™—is designed to:

  • Interrupt destructive patterns quickly

  • Increase accountability in both partners

  • Rebuild respect, trust, and emotional connection

That level of work doesn’t fit into an insurance model.

Privacy Matters More Than You Think

When you use insurance:

  • A diagnosis becomes part of your permanent medical record

  • Insurance companies can review your treatment

  • Your information may be shared with third parties for reimbursement purposes

When you pay privately:

  • Your therapy remains confidential and protected

  • There’s no required diagnosis

  • The focus stays where it belongs—on your relationship, not a label

You’re Investing in Your Relationship—Not Just a Session

Couples therapy is not just about talking.

It’s about:

  • Breaking years of unhealthy patterns

  • Learning how to communicate without escalation or shutdown

  • Rebuilding emotional and physical intimacy

  • Deciding—clearly and confidently—whether to stay together or separate

This is some of the most important work you will ever do.

And it deserves:

  • Focus

  • Depth

  • Expertise

  • A model that actually works

What I Offer Instead

At Richie Pryor Psychotherapy | Cape Cod Couples Counseling, I provide:

  • Evidence-informed, results-driven couples therapy

  • Relational Life Therapy (RLT)-based approach

  • My R.E.L.A.T.E. Method™ for structured relationship change

  • Couples intensives for faster breakthroughs

  • Discernment counseling when you’re unsure about staying or leaving

All designed to help you:

  • Stop the same fights

  • Understand what’s really happening beneath the surface

  • Reconnect in a meaningful, lasting way

Can You Still Use Insurance at All?

While I don’t bill insurance directly for couples therapy:

  • You may be able to use out-of-network benefits

  • I can provide a superbill upon request

I recommend contacting your insurance provider and asking:

“Do I have out-of-network benefits for mental health services (CPT 90847)?”

The Bottom Line

Insurance treats individuals.
I treat relationships.

And those are not the same thing.

If you’re looking for:

  • Real change

  • Honest, direct work

  • A structured approach that goes beyond surface-level communication tips

Then you’re in the right place.

Take the Next Step

If you’re ready to stop repeating the same patterns and start changing your relationship:

Submit your intake
Submit your intake