Question: Does insurance cover treatment for borderline personality disorder?
I have been in therapy on and off for years, but was recently diagnosed with borderline personality disorder. My therapist has referred me to a DBT program at a local hospital. I am excited about a program that is designed just for people like me, but I do not think I can pay for it on my own. I have an HMO and they only approved six sessions, but the program lasts over a year and consists of group and individual sessions. Another person says her insurance does not cover any of her treatment in this program. Is my insurance going to cover my treatment?
Answer:
The bottom line: In general, coverage can vary greatly between plans and carriers. Borderline personality disorder (BPD) is a mental disorder that many insurance carriers do not provide coverage for, but some do provide coverage for the treatment of symptoms related to BPD.
The DSM-IV classifies all personality disorders, including BPD, as “axis II” disorders. Insurance carriers tend to see all axis II disorders as being long-term and non-acute, and therefore not something that meets the criteria for behavioral health coverage.
Often clinicians are able to address this problem by requesting coverage for the treatment of the accompanying symptoms such as depression, anxiety, and/or substance abuse issues. This practice allows the client to get the services they need for the presenting symptoms of the disorder, but may inhibit treatment of underlying personality disorder, as it may not be the focus of treatment or even diagnosed.
In addition, even if coverage for BPD is available, insurance may not cover treatment as needed. For example, there are treatment programs, such as dialectical behavioral therapy (DBT), that have been found to be effective in the treatment of BPD. However, many insurance plans will not cover the treatment. Many plans cover a limited number of sessions a year, sometimes as few as ten sessions. Some plans will not authorize all of the sessions available to the insured for the calendar year, or will only authorize a handful at a time. Some plans will not reimburse clinicians for extended sessions.
Although the lack of clear insurance coverage for BPD can be frustrating, it is important not to let this deter anyone from seeking therapy. Treatment for BPD needs to be consistent if it is going to be effective. Therefore, it is important that individuals know what their benefits are, and discuss plans for to continued treatment with their therapists as soon as possible.
