TRICARE South family having a disagreement


Marriage Counseling, Family Therapy and TRICARE

TRICARE covers behavioral health care only for beneficiaries with a valid behavioral health diagnosis.
Counseling services that are not medically necessary for treatment of a diagnosed medical condition (e.g., educational, stress management and lifestyle modification counseling) are not covered. Although marriage counseling and family therapy may seem similar, under TRICARE, family therapy is covered, while marriage counseling is not.

Marriage Counseling

Marriage counseling does not indicate the presence of a valid diagnosis; therefore, it is not covered by
TRICARE. However, you can inform your TRICARE beneficiaries about available resources that may help improve their relationships.
Military OneSource:
Offers up to six cost-free, confidential counseling sessions to eligible military personnel and their family members. Beneficiaries can visit Military OneSource online or call 1-800-342-9647 for details.
Military and Family Life Consultants:
Provide service members and their families with face-to-face, non-medical counseling and education about daily life stressors related to deployment and reintegration. Beneficiaries can visit MHN Government Solutions online or call 1-800-646-5613 for details.
Online Behavioral Health Resource Center:
Humana Military Healthcare Services, Inc. (Humana Military) offers an online behavioral health resource
center to TRICARE beneficiaries in the “Health and Wellness” section.
You can also advise beneficiaries to check with their local military treatment facility to see if it offers marriage counseling, or to look into community-based services (e.g., social service agencies, community groups or church-based couples/family services).

Family Therapy

Family therapy is considered outpatient psychotherapy and is a TRICARE covered benefit when it is determined to be medically or psychologically necessary for treatment of a valid diagnosed behavioral health disorder.
Family therapy may involve all or a portion of the family. The family generally includes the spouse of the patient with the behavioral health disorder and his or her children. In the case of a child patient, it includes
the parents, step-parents, guardians and siblings. When it is determined appropriate, other family members residing in the same household can be included.
Outpatient therapy is limited to a maximum of two sessions per week in any combination of individual, family or collateral sessions. Beneficiaries can self-refer to a TRICARE network provider for the first eight outpatient family therapy visits per fiscal year (Oct. 1–Sept. 30). However, certain provider types always require a physician referral, even for the first eight visits (e.g., licensed professional counselors, licensed mental health counselors and pastoral counselors). All visits beyond the initial eight outpatient visits require prior authorization from Humana Military.
TRICARE Prime beneficiaries must use network providers to avoid significant out-of-pocket costs.
Note: Except for services authorized under Military OneSource, ADSMs must have a referral from their PCM for all civilian behavioral health care services prior to the services being rendered by a TRICARE-authorized provider.

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Last Reviewed: July 29, 2009