Uh, Is Health Coaching Covered By Insurance? Here's The Simple Answer

Health coaching is a quickly emerging field in the health care industry. Coaches work closely with clients to help them work toward their health goals—be it losing weight or sleeping better. While they can't prescribe medication or run tests, coaches guide clients using a combination of personal support, motivation, and positive psychology.

As more people begin to benefit from personalized coaching, the American Medical Association (AMA) is taking note. "By bridging the gap between the physician and patient, health coaches can help practices improve patient engagement in their care, leading to healthier patients with better outcomes," reads a recent statement by the AMA.

Insurance isn't the most straightforward topic, but the simple answer to this question is not really.

As of 2020, health coaching sessions (individual and group sessions administered by a certified coach) are considered Category III services. In insurance terminology, they are emerging services that don't yet have enough data backing them up to warrant widespread use (compared to Category I services, which are accepted across the board). While most insurers accept Category I claims, they do not accept Category III claims under normal circumstances.

That said, Category III is a temporary designation. Once an emerging industry is granted this status, it has the green light to compile the evidence and data needed to move to Category I. Many in the field are optimistic that health coaching will soon work its way up this insurance legitimacy ladder.

For now, the best way to save some cash on your health coach sessions is to dip into your flexible spending accounts (FSA) or health savings accounts (HSA). In order to use these pretax funds, you'll need to submit a letter of medical necessity from your primary care provider that explains why the health coaching service is needed.

This last piece is especially important. Most doctors have relatively little time to spend with each patient, and the average primary care exam visit only lasts 18 minutes. Health coaches can play a much more hands-on role and take their time to help translate doctors' orders into a digestible plan for patients. Research also finds that the "peer-like" relationship that develops between coaches and clients2 helps people feel like they're more in control of their own health. The power dynamic that exists in a doctor's office fades once you step into a coaching session. For these reasons, many doctors are starting to see health coaches as partners in patient care. Gaining insurance coverage will help this increasingly important industry become more accessible to the masses.

If you're looking for a health coach (or even thinking about becoming one yourself), it's important to pay attention to certifications. In order to submit for insurance, coaches currently need to be certified by either the NBHWC or the NCHEC. Coaches have to complete a certain number of practice hours and pass an exam before they can achieve these certifications.