TRICARE’s website has some terrific information available to participants on it. One question that seems to come up time and again for spouses is whether or not marital counseling is covered.
Family therapy is covered (just not under the title “marriage counseling”). However, marital counseling appears to be in a slightly different category (behavioral health). TRICARE explains that marital counseling is only covered at such time that it is medically necessary to treat another diagnosis—one that is a behavioral health condition (conditions covered in the DSM IV). There are costs to consider which are associated with this type of care as well. The breakdown from the official TRICARE website is as follows:
|
Psychotherapy (Outpatient Mental Health) |
TRICARE |
TRICARE |
TRICARE |
|
ADFM |
None |
15% |
20% * |
|
Retirees and Others |
Individual/Family Therapy $25 |
20% |
25% * |
· TRICARE Standard beneficiaries may be required to pay up to 15% above the TRICARE allowed amount when using a provider that does not participate in TRICARE.
Individuals who do receive authorization for marriage counseling will likely be treated by a Licensed Marriage and Family Therapist (LMFT). TRICARE explains that these care providers hold at least a Masters in counseling. LMFT’s do not prescribe medication as they are not doctors. Individuals requiring mediation for a behavioral health condition might be treated by a psychiatrist (and in some cases a Certified Psychiatric Nurse Specialist who can manage medications).
Also, TRICARE announced last December that, “Behavioral Health Provider Locator and Appointment Assistance Service is a dedicated toll-free telephone line at 1-877-747-9579.” However, it is important to note that, “[r]eferrals and prior authorizations may be required for behavioral health care depending on what type of TRICARE health care plan option you have. If you are seeing more than one provider, it is essential to keep all parties informed so that all are aware of any medications and treatment you may be receiving.” Be sure to check on your plan before contacting a provider to save yourself from hassles.
For more information on Behavioral Health Care, visit the TRICARE website: http://www.tricare.mil/.
Additionally, please read: http://www.humana-military.com/south/provider/tools-resources/Bulletins-Newsletters/I5-09/marriage-counseling-and-family-therapy.asp