Anna & Esther: A Pet Therapy Team in the Making

Animal-assisted therapy (AAT) has become one of the most meaningful and clinically valuable tools in mental health, hospice care, trauma recovery, and bereavement support. Decades of research show measurable psychological and physical benefits, yet most U.S. insurance plans still do not cover the service directly, even though the evidence is strong (Fine, 2019).

As someone studying and engaged in grief and end-of-life work, and as a handler training my Saint Bernard, Esther, for therapy-dog work, I see every day how powerful the human–animal bond can be. A single moment of connection can calm panic, reduce suffering, and open space for meaningful conversation.

So why isn’t this covered? And what needs to change?

What Insurance Covers — and What It Doesn’t

Medicare

Medicare currently does not cover AAT for mental health, hospice, or rehabilitation.
The clinician may be reimbursed for psychotherapy or occupational therapy, but the animal’s role is not recognized as part of the billable service.

Medicaid

Some state Medicaid plans allow animal-assisted therapy when:

• it is delivered by a licensed clinician
• it is goal-oriented
• it is part of a documented treatment plan

However, this varies significantly by state and is not standard practice.

Private Insurance

Some treatment programs incorporate AAT and accept insurance, but the session is billed under standard CPT codes (e.g., psychotherapy, OT, PT) — not because the animal is recognized in policy. Many private plans explicitly exclude “pet therapy.”

This mismatch between evidence-based benefit and insurance policy is the heart of the problem.

🐾 The Evidence Is Clear: AAT Works

Peer-reviewed research has repeatedly demonstrated the benefits of animal-assisted therapy:

1. Trauma, Anxiety & Depression

Interacting with therapy animals reduces cortisol, anxiety, and emotional distress (Pendry et al., 2019; Pendry et al., 2020).
A systematic review found that AAT significantly improves PTSD symptoms and emotional regulation (O’Haire, 2017).

2. Hospice & Palliative Care

In end-of-life care, AAT decreases pain perception and improves emotional well-being (Diniz Pinto et al., 2021).

3. Grief & Bereavement

Animals help create emotional safety, which encourages deeper expression of grief — a key part of Worden’s mourning tasks. AAT supports children in processing difficult emotions and trauma (Dietz et al., 2012).

4. Child Emotional Regulation

Human–animal interaction boosts oxytocin and reduces stress hormones, grounding children during periods of emotional upheaval (Beetz et al., 2012).

5. Physical Rehabilitation

A meta-analysis found that AAT improves mobility, motivation, endurance, and social functioning (Nimer & Lundahl, 2007).
In pain management, therapy animals reduce both reported pain and physiological stress (Marcus, 2012).

The research base is robust, consistent, and multidisciplinary.

💔 Why This Matters for Grief and End-of-Life Care

People who are grieving — or approaching the end of life — often describe intense emotional pain, fear, and loneliness. A therapy animal provides:

• grounding during traumatic grief flashbacks
• comfort during anticipatory grief
• quiet support for families in hospice
• gentle space for children to open up
• reduced anxiety during medical or counseling appointments

These aren’t “extras.”
They are clinically meaningful interventions supported by evidence (Cherniack & Cherniack, 2014).

Over 20 years of research, no major study has found harm when therapy animals are appropriately trained, screened, and handled.

🏛 Why Insurance Should Cover Animal-Assisted Therapy

1. AAT is evidence-based

The literature supporting AAT is stronger than many therapies already reimbursed (Fine, 2019).

2. It reduces healthcare costs

Lower anxiety, decreased need for sedatives, improved therapy participation, and better rehabilitation outcomes all translate to cost savings (Marcus, 2012).

3. It improves access to care

Patients and families are more willing to attend therapy when a trained animal participates (Geist, 2011).

4. AAT is regulated and safe

Organizations like Pet Partners and IAHAIO have rigorous standards for infection control, behavior testing, and handler education (Fine, 2019).

5. It increases equity in mental health and hospice care

Families shouldn’t have to pay out of pocket for an intervention shown to reduce suffering across multiple populations.

🔎 What Needs to Change

To make AAT reimbursable, health systems must:

• develop CPT codes for animal-assisted interventions
• include AAT in Medicare/Medicaid mental health and hospice benefits
• educate insurers about evidence-based outcomes
• require licensure + certified animal-handler teams
• ensure clear safety, infection-control, and documentation standards

This is achievable.
The research already exists.
Policy just needs to catch up.

📣 How Families Can Advocate

When calling your insurance provider, use this script:

“My provider incorporates animal-assisted therapy as part of a clinically appropriate treatment plan.
Is this covered under my mental health or rehabilitation benefits?
Are there exclusions for animal-assisted therapy?
What documentation does my clinician need to submit?”

Families can also write to:

• state Medicaid offices
• hospice agencies
• hospital advisory boards
• legislators working on mental health parity

Advocacy is how change begins.

Final Thoughts

As a thanatology student and grief-support advocate, and as someone training my own animal partner, I see firsthand how essential this modality is. Animal-assisted therapy is not cute, trendy, or optional. It is healing, evidence-based, and deserving of recognition in U.S. healthcare policy.

Insurance coverage won’t just save money.
It will ease suffering — one visit, one family, one therapy dog at a time.

References:

• Beetz, A., Uvnäs-Moberg, K., Julius, H., & Kotrschal, K. (2012). Psychosocial and Psychophysiological Effects of Human-Animal Interactions: The Possible Role of Oxytocin. Frontiers in Psychology, 3(234). https://doi.org/10.3389/fpsyg.2012.00234
• Cherniack, E. P., & Cherniack, A. R. (2014). The Benefit of Pets and Animal-Assisted Therapy to the Health of Older Individuals. Current Gerontology and Geriatrics Research, 2014(1), 1–9. https://doi.org/10.1155/2014/623203
• Dietz, T. J., Davis, D., & Pennings, J. (2012). Evaluating Animal-Assisted Therapy in Group Treatment for Child Sexual Abuse. Journal of Child Sexual Abuse, 21(6), 665–683. https://doi.org/10.1080/10538712.2012.726700
• Diniz Pinto, K., Vieira de Souza, C. T., Benamor Teixeira, M. de L., & Fragoso da Silveira Gouvêa, M. I. (2021). Animal assisted intervention for oncology and palliative care patients: A systematic review. Complementary Therapies in Clinical Practice, 43(101347), 101347. https://doi.org/10.1016/j.ctcp.2021.101347
• Fine, A. H. (2019). Handbook on animal-assisted therapy : foundations and guidelines for animal-assisted interventions. Academic Press is an imprint of Elsevier.
• Geist, T. S. (2011). Conceptual Framework for Animal Assisted Therapy. Child and Adolescent Social Work Journal, 28(3), 243–256. https://doi.org/10.1007/s10560-011-0231-3
• Marcus, D. A. (2013). The Science Behind Animal-Assisted Therapy. Current Pain and Headache Reports, 17(4). https://doi.org/10.1007/s11916-013-0322-2
• Nimer, J., & Lundahl, B. (2007). Animal-Assisted Therapy: A Meta-Analysis. Anthrozoös, 20(3), 225–238. https://doi.org/10.2752/089279307×224773
• O’Haire, M. E., Guérin, N. A., & Kirkham, A. C. (2015). Animal-Assisted Intervention for trauma: a systematic literature review. Frontiers in Psychology, 6(1121). https://doi.org/10.3389/fpsyg.2015.01121
• Pendry, P., Carr, A. M., Gee, N. R., & Vandagriff, J. L. (2020). Randomized Trial Examining Effects of Animal Assisted Intervention and Stress Related Symptoms on College Students’ Learning and Study Skills. International Journal of Environmental Research and Public Health, 17(6), 1909. https://doi.org/10.3390/ijerph17061909
• Pendry, P., & Vandagriff, J. L. (2019). Animal Visitation Program (AVP) Reduces Cortisol Levels of University Students: A Randomized Controlled Trial. AERA Open, 5(2), 233285841985259. https://doi.org/10.1177/2332858419852592