What to do when you can't afford DBT

How to afford DBT with a Philadelphia DBT Therapist

You’ve been struggling for quite a long time. Your mood swings, your emotions, and your relationships are intense. Actually, your whole life feels so out of control.

Whether it’s engaging in self-harm, reckless driving, substance abuse, or any other dangerous, destructive behavior, you know something has to give. You know you can’t continue to live like this- ruining relationships, self-sabotaging, and continuing to suffer.

You’re at your wit’s end. You feel like you’re going crazy or perhaps, you’re already there.

You’ve finally found a treatment that can help you. That treatment is Dialectical Behavior Therapy.

You researched DBT and finally, you feel like something can help you. You finally have hope that your life isn’t doomed. You discover that DBT is the treatment of choice; the “Gold Standard” for what you’re going through- for emotion dysregulation; for not ruining relationships; for borderline personality disorder.

You begin to research DBT Programs and DBT therapists. Your heart drops. You find very few providers who provide Comprehensive DBT. In addition, the ones you found do not accept insurance and Comprehensive Dialectical Behavior Therapy is expensive; more expensive than you can afford.

You ask yourself, “How am I going to get better if I can’t afford DBT?”

Due to the intensive specialization, there are fewer DBT therapists than general therapists or counselors. Having to maintain and adhere to the high degree of standards in Dialectical Behavior Therapy, many providers do not work with insurance companies due to the very low reimbursement rates.

This can make it incredibly challenging and difficult to afford Comprehensive Dialectical Behavior Therapy. All of this can make it feel even more overwhelming for you when you’re trying to find the help that you so desperately need.

What to do when you can’t afford DBT?

There’s no doubt that our current medical system is complicated and flawed. It feels so overwhelming, particularly when you are desperately looking for help. As a DBT therapist, I don’t work with insurance companies for a variety of reasons. While insurance companies can be so super confusing for most people, there are ways that can help you navigate the insurance company system effectively and hopefully help you get the treatment you need.

I’ve broken down the steps to help you find the treatment you need when you’re trying to get your insurance company to pay for Comprehensive Dialectical Behavior Therapy.

Help! I’ve found a DBT therapist and they don’t accept my insurance. Now what?

DBT therapists and programs who have gone through highly specialized and extensive training, maintain treatment that is consistent with the research on the efficacy of Comprehensive Dialectical Behavior Therapy. The reality is that most DBT therapists who adhere to the Gold Standard, research-supported, Comprehensive DBT standards don’t accept insurance.

Despite most DBT programs and DBT therapists not accepting insurance, there are some options that can help you.

Let’s be real. Insurance companies are not typically in it to “help”. They are about profit.

Knowing this, as we say in DBT, how can we be effective?

How to Get Your Insurance Company to Pay for DBT

Sometimes you need to “play the game”. What does that mean? It means how can you effectively get your insurance company to help pay for your DBT therapy?

Below, I’ve listed some tips to help you navigate dealing with your insurance company.

How to “Play the Insurance Company Game”

1. Call your insurance provider and find out what type of benefits you have. You will most likely be told one of two things. You may have an out-of-network benefit. Alternatively, your insurance tells you that you must use an “in-network” provider on their “approved” panel or list.

2. If you have out-of-network benefits, that means you are entitled to some sort of reimbursement. It means you’ll most likely have to pay upfront and then submit for reimbursement. In my private DBT practice, I offer an out-of-network calculator that you can use for free to determine what you’re entitled to. Click HERE to access this free tool.

3. If your insurance tells you that they have DBT specialists in-network and that you must use one of their “approved”, in-network therapists, here is what you’ll need to do.

4. Get the insurance company’s in-network “list” and go through it to see who the insurance company says provides DBT.

5. Reach out to each provider that’s on their “list”. Ask the program or clinician you contact the list of questions that are provided above.

6. Make sure to keep detailed records of who you spoke to at the insurance company and the dates you spoke to them. Also, keep track of each in-network provider you spoke to and their responses.

If you discover an in-network DBT program that has the necessary training and follows the researched and evidenced-based model of Dialectical Behavior Therapy, great!

If you follow these steps and find out that none of the insurance company’s in-network providers are qualified to provide Dialectical Behavior Therapy as designed and researched, there is another option. You may be able to get a “Single Case Agreement” or “SCA”.

What is a Single Case Agreement for DBT?

Finding a specialized treatment for borderline personality disorder that is covered by your insurance can be SO overwhelming, especially when you’re already dealing with so much.

A “Single Case Agreement” or “SCA” allows an out-of-network provider (e.g., DBT therapist) to be considered “in-network” for a single client (e.g., you). SCAs are often “approved” when someone requires highly specialized treatment (e.g., Dialectical Behavior Therapy) for a specific condition (e.g., Borderline Personality Disorder), and there are no in-network therapists or programs that provide that specialized treatment (e.g., DBT).

How do I get an SCA for BPD treatment?

Initially, even after going through the above steps, the insurance company may still say they have in-network providers who “do DBT”.  Unfortunately, as referenced above, this is highly unlikely that the in-network provider who has extensive training can be considered a DBT therapist.

In some cases, insurance companies are liable for providing you with necessary treatment if they don’t have in-network, “approved” treatment providers.

That means if you need specialized treatment for BPD (e.g., DBT), you are entitled to receive DBT, using in-network coverage.

Below, I’ve created a list of “tips” when speaking with your insurance company to help you “speak the language” of insurance companies.

Speak the Language Your Insurance Company Understands

What to say to your insurance company to get a Single Case Agreement for DBT.

1. First, you’ll need to reach out to the out-of-network DBT therapist who you’ve identified can help you and ask if they’d be willing to accept a Single Case Agreement. If they’re willing to accept an SCA, call your insurance company.

2. Most of the time, insurance company representatives do not know the difference between treatments. When you first ask about getting a Single Case Agreement (SCA) for DBT, you need to specify it as “Dialectical Behavior Therapy” and not “DBT”. This is because insurance companies frequently think you’re saying “CBT” or they believe “DBT” and “CBT” are the same thing. They are not.

3. Your insurance company may continue to state they have specialized providers who “do DBT”. This is when you need to refer to your detailed record keeping from when you already went through their in-network “list” and inform your insurance company that the therapist and programs that are on their in-network “list”, are not, in fact, extensively trained in Dialectical Behavior Therapy and/or comply with the evidence and researched model of Comprehensive DBT.

4. You may need to request that you speak to a supervisor or another representative who has a specific understanding of Dialectical Behavior Therapy if you’re not able to get anywhere with the current person you’re talking to. Again, this is because most insurance company representatives don’t know the specifics about DBT and/or know the differences between various therapies or treatments.

5. Inform the insurance representative that you’ve already spoken to the out-of-network DBT therapist, who adheres to the research-backed standards of Comprehensive DBT and they are willing to work with a Single Case Agreement.

6. You need to be aware that once the process has started to get an SCA, your insurance company will most likely need you to provide evidence (i.e., justify) why you need specialized treatment (i.e., DBT). In other words, most insurance companies will need you to experience the symptoms consistent with Borderline Personality Disorder (e.g., emotion dysregulation, behavior dysregulation, such as self-harm, suicidality, or inpatient psychiatric hospitalizations).

7. Please know that you will most likely have to put in A LOT of effort to be approved for an SCA. Most SCA requests will be initially denied and you will need to appeal.

8. Request to speak to, or be assigned a “patient advocate” at your insurance company if you’re not getting anywhere with them.

A special note about Comprehensive DBT and obtaining an SCA.

Unfortunately, this again boils down to money and how much it will cost the insurance company.

As I’ve written about extensively, DBT is different than many other treatments and therapy approaches. In addition to THESE REASONS, there’s another very important difference that insurance companies need to know.

DBT requires that clients make progress in their treatment (i.e., improve) in order to stay in DBT.

This is done through structured assessment tools such as the DBT Diary Card. Many other treatments and therapies are not like this.

In fact, many other treatment and therapy options have clients remain in treatment longer if they are NOT improving. 

Insurance companies are more willing to cover the cost or approve an SCA for DBT because research has demonstrated that DBT therapy reduces the symptoms and behavior consistent with BPD, specifically problems associated with emotion dysregulation, self-harm, and suicidality. This, in turn, decreases the need for higher levels of care (e.g., inpatient psychiatric hospitalization or partial hospitalization). Translate to “insurance company-speak”. It'll cost them less money to cover DBT.

Only adherent DBT programs (those that provide all four components of Comprehensive DBT in the way that is supported by research) can be confirmed as demonstrating a cost reduction for insurance companies.

Using the language that insurance companies understand, Dialectical Behavior Therapy is a treatment that has been shown to reduce the long-term costs for insurance companies. In other words,

The take-home message: Comprehensive DBT is a cheaper option for insurance companies. 

Philadelphia DBT

I know that the last thing you want to do when you’re overwhelmed and looking for help, is to navigate finances. Please know that all is not lost. While you will need to put in a lot of effort with your insurance company, and DBT is worth it. It may be the one treatment that can help get you out of hell.

DBT Therapy Philadelphia

As a Philadelphia DBT therapist, I specialize in Dialectical Behavior Therapy, borderline personality disorder treatment, comprehensive DBT, and anxiety therapy. If you’re struggling with intense, painful emotions, self-harm, or debilitating anxiety, reach out now.

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