fighting insurance companies for DBT?

[lighthouse9]

Hi everyone - can someone direct me to any resources on how to get insurance companies to cover DBT? Everything was going great, my wife filled out an intake form, I filled one out too, we're just waiting to get our referrals and BAM I just found out that this place is no longer in network, even though they will accept our insurance. I'm sick over this. So much hope riding on this counseling working out.

Any suggestions? I've already contacted my doctor to see if he'll write a note pushing the insurance company, but I don't know him well enough to know if he'll do this for me. My wife says she'll just find "anybody in network," but I've seen some of our in network therapists and they're absolute crap and have zero ability to spot or talk about BPD. I asked her for one month of counseling for herself before she decides on filing for divorce or not, and I'm afraid that someone who doesn't get BPD will just back up all of her assertions that are based on her splitting me right now. help!

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[flourdust]

If they aren't in network, you can call the insurance company and ask to speak to a patient care advocate. That would be the person (the title may vary) who can evaluate if they can issue a waiver to allow the treatment center to bill as in-network for you. (If DBT isn't available elsewhere in your area, that would be a reason they would issue the waiver.)

Is the issue that they won't pay for treatment for BPD? That's not uncommon. If your wife has a comorbid diagnosis (anxiety, bipolar, etc.), it might be more effective to submit the DBT as treatment for the other diagnosis.

[teapay]

I'd agree with Flour.  I would add, though, making sure it is a real DBT program with both group and individual sessions, not just some counselor with a store bought workbook.  Also, I didn't see results from my wife's DBT until after a solid year of treatment, but eventually she did take to it.  The DBT was helpful against extreme behaviors such as suicide ideation, self harm and more severe impulses.  It didn't get at the underlying problems with self identity and instability, distortions, dependency and other things.      If your wife is able to develop her own sense of self through therapy, she might change from who she is now, but also into someone else quite different than you expect or hope for.