For many people, one of the biggest barriers to seeking therapy is insurance. Will your insurance cover your appointments? Will they require jumping through hoops with referrals and authorizations? Are you limited in what providers you can see in-network?

The truth is, this is a very difficult question to answer. Not only does every insurance provider have different rules, but different plans can have different requirements or limitations you need to figure out. It’s enough to stop many people from getting the help they need.

When it comes to dialectical behavior therapy, there’s some good news. Since DBT is an evidence-based method with a proven track record, it’s generally treated as legitimately as it can be within an insurance paradigm, and most insurance providers will cover it. Unfortunately, determining whether or not your specific plan covers it can be tricky.

DISCLAIMER: This article is for informational and educational purposes only and should not be considered medical or psychological advice. The information presented here is not intended to diagnose, treat, cure, or prevent any mental health condition or replace professional therapeutic care. Every individual's experience with trauma and mental health is unique. Please consult with a qualified mental health professional, therapist, or healthcare provider to determine the most appropriate treatment approach for your specific situation. If you are experiencing a mental health crisis or emergency, please contact your local emergency services or crisis hotline immediately.

What Insurance Providers in Metro Detroit Cover DBT?

As we mentioned above, the good news is that most insurance providers are likely to cover DBT in broad strokes. We don’t know of any providers offhand that entirely refuse to cover DBT, because it’s a proven treatment for serious issues like complex PTSD, and is often medically necessary.

If your insurance comes from:

• Blue Cross Blue Shield of Michigan
• Blue Care Network
• Aetna
• Priority Health
• United Healthcare
• Health Alliance Plan
• McLaren Health Plan
• Meridian
• Molina
• University of Michigan Health Plan
• Medicare/Medicaid (including the Healthy Michigan Medicaid Expansion)

There’s a good chance that it will cover some form of mental healthcare, including DBT.

The difficulty is that even though a provider will cover mental healthcare in general, it doesn’t mean the specific plan you’re on will cover it. You will need to check with your specific plan to see what it covers and what limitations you might run into.

Do Any Providers Explicitly Not Cover Mental Healthcare?

Not that we know of. In Michigan, both state and federal law require at least some kind of mental healthcare coverage from all insurance providers. Some put more barriers between you and the coverage you need than others, though.

Whether or not DBT specifically is covered is also a question. While DBT is a proven and valuable technique for addressing mental health concerns, it’s not the only option available, and some health insurance providers might want to nudge their clients in specific directions for one reason or another.

Usually, when an insurance provider is going to exclude certain kinds of services, they’re services that aren’t as proven; things like aromatherapy, holistic medicine, or Reiki healing. Proven treatments like CBT, DBT, EMDR, and others are usually covered.

Can You Get DBT Without Insurance Coverage?

Of course!

As you might expect, there will be a fee, due at the time of service, if you aren’t billing insurance. Even if you are billing insurance, you will need to be able to pay your co-pay and deductibles as required based on your coverage.

Some providers, though not our office, offer sliding fee scales for low-income patients seeking services. It never hurts to ask any potential service provider when you’re considering scheduling an appointment.

The specific costs you may be responsible for can range from $50 to $300 per session, depending on whether it’s an individual session or group session. If you are using your insurance, your costs will be based on your specific policy coverage. If you are paying cash (either because you don’t have insurance or choose not to use your insurance), the pricing can vary by provider.

What Roadblocks Might You Run Into?

It’s important to figure out if your insurance will cover mental healthcare, and if it will cover DBT specifically. Below, we’ve outlined some of the common issues we see people run into, so you can make sure to ask your provider about these details.

Insurance that Carves Out a Mental Health Coverage Plan

One issue we frequently see is that many mental health providers are also general medical providers.

What this means is that if you call a provider’s offices and ask if they accept a specific insurance, the person you’re talking to might answer yes; however, they might accept the medical portion of the insurance, but not the mental health portion of the insurance. This variance can be a rude surprise to some people whose insurance plan carves a line between the two services.

Your insurance provider should generally have an explanation of benefits available for your plan, which you can check to see if it carves out mental healthcare as a separate portion of the plan, or if it’s all part of the same plan. There will often be a section explaining what your responsibilities would be for mental health services, whether they’re inpatient or outpatient, in-network or out-of-network, and whether they’re office visits or remote visits.

In-Network Versus Out-of-Network Coverage

Network coverage is one of the biggest headaches in all of insurance. Insurance networks work with specific providers to reimburse those providers for services rendered to patients. There are basically two possible options.

The first of the options is that your insurance will cover most or all of the costs associated with in-network providers, subject to the specific co-pays and deductible limits on your plan. Out-of-network providers will also be covered, but at a lower rate, so you will end up having to pay more for the services, but still less than if you were to pay without insurance coverage at all. This is often what PPO plans do.

The second option is that the insurance provider will cover the costs of services for in-network providers, but will not do anything for out-of-network providers. These are usually the lower-cost insurance plans that are able to offer coverage at that lower cost because of the restrictions they put into place. This is usually how HMO plans function.

Provider Certification Requirements

Another potential stumbling block that can come up is a requirement that the specific practitioner who is providing your DBT be certified with the DBT-Linehan Board of Certification. This Board is the legacy of the inventor of DBT, and can certify both individual clinicians and DBT programs.

It’s not necessarily common, but you might run into issues if you’re getting DBT from someone who, even if they know their way around DBT and have been providing care for years, isn’t specifically certified with that board.

Preauthorization or Medical Need Requirements

A more common reason that insurance causes problems in seeking DBT is the dreaded roadblock of preauthorization. You may not be able to just call and schedule DBT; you may need to talk to your general practitioner and get a referral, or call your insurance company and get a preauthorization for the services.

In some cases, your insurance provider might request proof that the treatment is medically necessary. They might also request that you have tried other forms of therapy or treatment first. This isn’t as common in mental healthcare as it is with certain kinds of physical healthcare, but it does still come up from time to time.

Fortunately, this is usually a temporary stumbling block; once you’ve cleared the hurdle, the necessity is on record, and your therapy should be covered on an ongoing basis until such time as you reach any plan limits.

If you are required to get preauthorization or proof that treatment is medically necessary, make sure to retain the paperwork in case there are issues down the line.

How to Verify Your Insurance Will Cover DBT

All of the above can be daunting, but fortunately, it’s not that onerous of a burden to verify whether or not your insurance will cover DBT, and if you need to do anything special to get started.

Call Your Insurance Provider’s Contact Number

The easiest option is to give your insurance provider a call. Your insurance card will have a contact number on it, and if you aren’t sure where that card is, you can look up the information on their website.

You might also be able to use a website-based chatbot to ask your questions as well, if a phone call is itself daunting.

You will usually have to navigate a phone tree and reach an agent to discuss aspects of your policy, and they will be able to check with your specific plan and see if it covers DBT as a mental healthcare service.

There are two related questions to ask here.

The first is whether or not DBT is covered under your insurance at all. The second is whether or not the specific provider you were looking into is covered in-network with your insurance. If you aren’t sure what provider you want to work with, you can request a directory from your insurance company; they generally have booklets they will mail to you, or a PDF they can email to you, or a directory on their website. In fact, that might be your next stop.

Check Your Insurance Provider’s Directory

Your insurance provider will have a directory of providers they work with in their network. The easiest way to access this, if it’s available, is to check with your insurance provider’s website. For example, Blue Care Blue Shield of Michigan has a “Find Care” section on their website; if you’re logged in, you can use that directory to seek providers for specific services near you. You can also look for remote providers who are licensed to provide care in Michigan as well.

There are also third-party directories you can check. These aren’t always accurate or comprehensive, but they can get you started. For example, Zencare allows you to search for specific services in specific locations, such as showing you all of the therapists in Michigan in their list.

Call Potential Providers Directly

If you’ve verified that your insurance plan covers DBT, you can then start calling providers to ask if they accept your insurance.

Don’t forget to make sure to clarify that you’re talking about DBT specifically, since, again, sometimes an office will accept an insurance, but specific providers don’t.

What to Do if Insurance Denies Your Care?

Even if you think you’ve done everything right, found a good provider in-network and have gotten your authorization, sometimes insurance has an unwelcome surprise and denies your care. Distressingly, the first sign of this is often an unexpected bill.

Before you panic, appeal. Denial of care isn’t necessarily final, and it can often be appealed and overturned. You may be able to appeal both on the grounds that the care should be covered, and possibly on the grounds of unequal treatment of care, which might happen if there are more hoops to jump through for mental health services than physical health services with your insurance provider.

The specific appeals process, deadlines, and details can vary, not just from provider to provider, but from place to place. This is also where evidence you gathered along the way, such as proof of preauthorization, can come into play.

Don’t forget to talk to your treatment provider. Service providers can also appeal an insurance decision from our end, and may be able to sort things out more quickly than your own appeals process.

Give Us a Call

At BMC Troy, we’re proud to provide a range of mental health services to the metro Detroit region.

At BMC-Troy, we’re proud to provide a range of mental health services to the metro Detroit region and may accept your insurance. Our office accepts many of the major insurance providers in Michigan, including:

• Blue Cross Blue Shield of Michigan PPOs
• Aetna / Cofinity
• Cigna / Evernorth
• Carelon (Formerly Beacon Health)
• Medicare
• United Healthcare / Optum
• Priority Health

Unfortunately, we are not a Medicaid provider at this time.

Definitely make sure to give us a call to discuss your specific insurance. Some of our therapists and providers are in-network for these insurances, but not others, so while our office in general may accept your insurance, the specific therapist or provider you saw on our staff page might not.

If you’re interested in how we can help you with EMDR or other types of therapy or medication management services, we’re more than happy to discuss your options. You can call us during work hours at (248) 528-9000, or leave us a message if it is after hours and we will call you back on the next business day. Our full contact information is available here.

If you would like to schedule an appointment, please complete our electronic form here!