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.

Although health coaching has gained legitimacy in the medical field, there's one final hurdle to tackle before it goes totally mainstream: getting it covered by insurance. Here's the latest on whether insurance will cover your health coaching visits—and why that may soon change.

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.

You can also see a coach through a functional care provider like Parsley Health, which accepts in-network insurance for its monthly membership plan in select states (currently New York and California).

The National Board for Health and Wellness Coaching (NBHWC) is the main certifying body for health coaches, and it's been instrumental in securing Category III status for the field. It's also leading the charge to achieve Category I designation by setting a high standard for its certified coaches, gathering evidence on the efficacy1 of health coaching, and increasing awareness of health coaching among primary providers.

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.

RELATED READ: The 5 Best Health Coach Certification Programs Of 2023

While health coaching sessions are not currently accepted by most major insurance providers, there's momentum to change that. Getting claims for this important service covered will be a big step toward making it accessible to those who really need it (read: most of us).