As you know, Whole Family Healing Group is a “Healing Place for the Whole Family”. We get
many inquiries from families and couples about coming to us for help with managing and
getting through challenges that all of us endure at some point or another in life. We get calls
from people stating that their insurance company told them that they pay for family/couples’
therapy. Whereas that may be true, the caveat is that many families want to come and get
help for situations that are classified in the DSM called Z-CODES.
So, to give you an example, a family or couple may want to come to therapy to deal with
“Relationship Distress With Spouse or Intimate Partner” (Z-Code) or “Parent-Biological Child”/
“Parent-Adopted Child Relational Problem” (Z-Codes). These are very important issues that do
need to be addressed in the company of a licensed professional, however, many times, the
insurance companies will tell us that the above stated cannot be the primary issue addressed or
submitted on medical documentation for reimbursement. It must be a primary diagnosis such
as Anxiety Disorder, Depressive Disorder, Bi-Polar Disorder, etc. These are issues classified as
ICD-10/F-Codes, also classified as medical necessity.
Z-Codes do not designate medical necessity as do the ICD-10/F-Codes. As a result, if you are
not already receiving individual therapy with us, and have no desire to do so, we will not be
inclined to accept your insurance as there is no guarantee that based on the family/relational
issue, we will be able to justify and document that there is a medical necessity for the issue
being addressed.
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