coTenacious Therapy
Frequently asked questions
Insurance can make therapy more financially accessible but it also changes how therapy is structured.
To use insurance, therapists are required to:
Assign a mental health diagnosis
Document symptoms and impairments to your ability to complete major life functions
Demonstrate “medical necessity”
Follow insurance company policies
Maintain records that may be reviewed by your insurance company at any time
This means therapy is shaped not only by your needs—but also by insurance requirements.
At CoTenacious Therapy we work to balance providing meaningful care while staying compliant with the systems that allow you to use your benefits.
Individual Therapy
Medical necessity means that therapy is needed to treat a mental health condition that is causing significant emotional distress, symptoms, or difficulty functioning in daily life. Treatment is considered medically necessary when it is expected to help improve, stabilize, or prevent worsening of those symptoms and functioning.
Examples of areas that may be affected include:
Work or school performance
Relationships and family functioning
Sleep, concentration, or mood
Ability to manage stress or emotions
Safety, self-care, or daily responsibilities
Insurance companies generally require that therapy:
Addresses a diagnosable mental health condition
Uses clinically appropriate treatment methods
Has clear treatment goals and measurable progress
Is provided at a level and frequency appropriate to the person’s needs
Family Therapy
Family therapy is considered medically necessary when family relationships, communication patterns, or caregiver dynamics are directly affecting the identified client’s mental health symptoms, recovery, or daily functioning.
Family sessions may help:
Reduce conflict or stress that worsens symptoms
Improve communication and emotional support
Strengthen coping strategies within the family system
Support treatment goals and recovery
Improve safety, stability, and functioning at home
In family therapy, the focus remains on supporting the identified client’s treatment needs and improving outcomes related to their mental health condition.
Therapy that does not meet medical necessity criteria
According to insurance companies, there are some services that are not medically necessary. This does not mean these services are unhelpful or unimportant, only that insurance plans will not pay for them.
Services provided for
Personal growth or self-improvement
General life stress without functional impairment
Wellness or maintenance without active symptoms
Socialization or companionship
Convenience of the client or provider
Supportive counseling without a treatment objective
Educational, vocational, or recreational purposes alone
Relationship counseling when no mental health diagnosis or functional impairment is present
Custody evaluations, court-ordered evaluations without treatment focus, or administrative requests
Therapy that is duplicative of another provider’s services
Maintenance treatment where sustained improvement is not expected and treatment is primarily to preserve prior gains without active symptoms requiring treatment
According to provider guides
“The goals of treatment are not primarily for providing support… or primarily self-improvement.”
“Not primarily for the convenience of the patient or Healthcare Provider.”
“Treatment is not duplicative of services being provided by another clinician for the same reasons/diagnoses.”
“The condition has not stabilized to the point where maintenance treatment is appropriate.”
Services must be “directed at a medical problem/diagnosis.”
Medical necessity is not met when treatment is not expected to improve symptoms, functioning, or prevent deterioration.
Maryland Insurance Administration Mental Health Resources (Maryland Insurance Administration)
Maryland Insurance Administration Consumer Guide to Mental Health Coverage (Maryland Insurance Administration)
Maryland Insurance Administration Appeals & Claims Information (Maryland Insurance Administration)
Maryland Coalition of Families — Out-of-Network Mental Health Protections (Maryland Coalition of Families)
Legal Action Center — Maryland Out-of-Network Protections FAQ (lac.org)
Mental Health Association of Maryland Insurance Protections Guide (mhamd.org)