Do You Take Insurance for Therapy in Washington State?
Starting August 1, 2026, I am in-network with Premera Blue Cross, Blue Cross Blue Shield, and Lifewise for individual therapy. Couples therapy, premarital counseling, and discernment counseling remain private pay. Here is what that means and why it works this way.
Is individual therapy covered by insurance?
Yes. If you have Premera, Blue Cross Blue Shield, or Lifewise, your individual therapy sessions may be covered after your deductible and copay, starting August 1, 2026. I can verify your specific benefits before your first session so you know your cost ahead of time, not after.
Why doesn't insurance cover couples therapy?
Insurance companies require a mental health diagnosis to pay for any service, and a relationship cannot be diagnosed. To bill insurance for couples work, one partner would have to be labeled the "identified patient," carrying a diagnosis on their permanent medical record so the claim can be processed. That label often does not reflect what is actually happening, and it can follow that person long after therapy ends.
In couples therapy, both partners are the client. Nobody is the one who is sick and nobody is the problem to be treated. Keeping this work private pay means the focus stays on your relationship, not on assigning a diagnosis to satisfy a claims requirement.
Does this apply to premarital and discernment counseling too?
Yes. Marriage by Design (premarital counseling) and discernment counseling are also private pay, for the same reason. Neither one involves treating a mental health condition. Both involve two people doing intentional work on their relationship, whether that is building a strong foundation before marriage or gaining clarity about the relationship's future.
What does it cost if insurance doesn't cover it?
Couples therapy and Marriage by Design are $150 per 50-minute session. Discernment counseling is $200 per 90-minute session. Individual therapy is $150 per session, billed to insurance if you are in-network with Premera, BCBS, or Lifewise, or paid privately if you prefer to keep it off your insurance record entirely.
Can I still pay privately for individual therapy even if my insurance is accepted?
Yes. Some clients prefer to pay privately for individual therapy rather than use insurance, often to avoid a diagnosis appearing on their medical record, or because they have a high deductible that makes private pay comparable in cost. If you pay privately, I can provide a superbill for possible out-of-network reimbursement.
The bottom line
Insurance works well for individual therapy, where one person is the client and a diagnosis reflects their actual experience. It was never built for relationship work, where the point is that nobody is broken and nobody needs fixing, just two people learning how to do this well together. Private pay for couples, premarital, and discernment work protects that frame. It keeps your relationship, your privacy, and your record in your hands, not an insurance company's.
If you have questions about what your specific plan covers, or whether individual or couples work is the better fit for what you're navigating, I offer a free 15-minute consultation to talk it through.
