If we are doing couples counseling, do we both need to register a separate account here?

Yes.  For HIPPA purposes, I am not able to provide two intake forms and consent forms on the same account. Each person is required to have their own confidential client portal and access to their forms, even if you are seeking couples counseling.

Do you bill insurance, or do we pay you first, and seek reimbursement from the insurance company ourselves?

The way my practice works, I request full payment at the time of the session ($130 for 50 minutes and $205 for 85 minutes) and I provide receipts which you are  then welcome to use for reimbursement.  The actual amount of reimbursement you would receive depends on your out-of-network benefits.  To find out the level of benefits, you simply contact the customer care # on your insurance card and request the following information:
1.  What are my out-of-network mental health benefits if I am seen by a PhD level clinical psychotherapist?
2.  What is my out-of-network deductible?
3.  How many sessions am I allowed per year?
4.  Where do I send claims for reimbursement?
5.  What is the typical length of turn-around time it takes you to reimburse a claim?

This should give you the information you need.  

I do offer the use of MC/Visa to offset the delay between payment and reimbursement