The Battle between DBT Treatment and Insurance Companies

By Lori Salmon, MSW

Dialectical Behavior Therapy (DBT) is an evidence-based treatment that has been found to be the gold standard for those suffering from Borderline Personality Disorder.  One of the elements that make DBT so helpful is the comprehensive treatment modality that is provided to the client.  This involves individual sessions, group therapy, phone coaching calls, and team consultation, which is far from the traditional practices of providing only individual sessions.  The complexity of the BPD diagnosis warrants the intricacy of an effective treatment.  Although mental health providers can agree with this thought, there is a continual battle with insurance companies for reimbursement.  Insurance companies do not recognize the full DBT modality as a billable treatment.  They may cover just the individual sessions and not even the full rate at that.  With DBT being a relatively expensive treatment, there is a frustration as a service provider of wanting to offer the most effective treatment to those who needed it the most and watching the insurance company deny the clients a financial reimbursement.  In many cases, clients are left to pay out of pocket which is a difficult task for those on disability or even those who come from a two income household.  Increasing awareness and advocating for effective mental health services is needed to illustrate to the insurance companies that there is not a one size fits all treatment for every disorder.  Although mandated federal laws have increased insurance coverage, we are still a long way from the proper mental health coverage, especially for personality disorders.  Having insurance companies recognize the full DBT modality as billable services would not only decrease the financial strain, but may also help increase the numbers of individuals who desperately need this treatment.


So what can we do?

As a consumer, it is easy to find a generalist mental health provider within network but without asking the right questions, the attempt to find a DBT program may fall short.  The evidence supports full DBT as the most effective treatment for BPD, so it is important to understand the treatment modality the therapist offers.  If a therapist on your insurance list claims that they provide DBT, then you must ask, “What does that entail”?  Their answer should be individual sessions, group therapy, phone coaching calls, and that they attend a DBT consultation team.  Also, ask what training and/or certifications they have completed.  Be cautious of providers that offer DBT, as this may not be the full DBT treatment modality and based on your needs, it may not be sufficient.  For some people some DBT is better than no DBT but be mindful that it may not be as effective.  Another question you can ask is if they offer a sliding scale fee or if they have any scholarships available.  These may help lower the cost of the treatment.  Furthermore, if you have insurance, contact the insurance company and advocate for your treatment.  Ask what they will cover and what can you do to have more coverage for this evidence-based treatment.  On a larger level, contacting local state legislators is another avenue to have our voices heard and policies changed.  The senator for parts of Hillsborough County, Pinellas County, and Manatee County is Senator Arthenia L. Joyner.  Senator Tom Lee also resides over parts of Hillsborough County.  Doing your part will help to advance mental healthcare coverage and help to improve the quality of life for those suffering from BPD.

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