Disclaimer:
The Dialectical Behavior Therapy (DBT) Center of Arizona does not accept any insurance. However, if you have a PPO (or better) insurance plan, you may have “out of network” coverage. Additionally, you may qualify for a “single case agreement” as stated below. We are “out of network providers”. You will need to pay our fees prior to each session (group and individual), and we will issue you a “superbill” (an insurance-ready receipt) that you would submit to your insurance company in order to help you get reimbursed for that portion of the session’s fees that you’re entitled to according to your out of network benefit or single case agreement. It is always best to contact your insurance company before starting at the DBT Center of Arizona in order to determine what that amount would be.
Arizona Law / How to Advocate for Specialty Treatment
In Arizona, if a consumer is seeking and advised to receive specialized therapy, they are entitled to receive it regardless of whether they have out-of-network benefits. What follows is the relevant statute of the Arizona Law. Please also carefully read the section on DBT.
Some clients have been able to get “A Single Case Exception” in order to go out of network and still only pay their normal in-network copay. The insurance company covers the remainder of the therapist’s normal full fee. This makes out of network therapy as affordable to you as in-network therapy and allows you to choose a specialist of your choice.
Your insurance company may try to convince you that they have a specialist in their panel who can meet your needs. However, in the Arizona, there are very few Adherent or Comprehensive DBT services in-network. Therefore, I encourage you to call any therapist who they say provides in-network DBT and ask a few questions. Included here are some guidelines to help you determine whether the provider is actually offering adherent DBT.
How to tell if someone is providing Adherent DBT
Dialectical Behavior Therapy (DBT) consists of four components:
- Weekly Individual DBT therapy with a DBT-trained clinician
- Weekly DBT skills training – usually conducted in a group, but on occasion done on an individual basis.
- Telephone coaching as needed to help the client use skills in daily life.
- Clinician consultation group. DBT requires that the therapist is in a consultation group with other DBT trained therapists.
Your insurance company may claim that they have clinicians in-network who “do DBT.” However, very often when clients follow up with these clinicians, they have found that the clinician
a) does not do DBT and does not claim to do DBT
b) has minimal training in DBT, incorporates a few DBT skills into -DBT therapy, but does not claim to be a DBT therapist.
c) claims to “do DBT” but, in fact, has minimal training, doesn’t separate out the skills component of DBT from the individual therapy session, and is not part of a DBT therapist consultation team.
d) Was trained in DBT and did practice it at one time, but does not currently offer a comprehensive program and doesn’t practice DBT at this time.
Without all of the above components, it is not DBT!
It is worth asking specific questions to any provider that the insurance company has given to you to make sure that they are actually doing DBT.
- Do you consider yourself to be a DBT therapist?
- Do you provide both the individual component of DBT and the skills component?
- If so, are they taught at the same time or at separate times?
- Do you belong to a consultation team with other DBT trained therapists?
- Do you use a diary or daily report card?
- Do you conduct chain analyses as part of therapy?
If you find that the therapists whose names you have been given by your insurance company are not DBT therapists, you can go back to your insurance company and ask for out-of-network treatment. I believe that the standard is that your insurance company has 48 hours to find you a specialist who you can see that is a reasonable distance from where you live.
If your insurance company cannot find you an in-network DBT therapist and DBT has been recommended as the treatment of choice for you, and they also refuse to give you a single case exception, you can appeal that decision to the state insurance commissioner.
We are also not AHCCCS providers. It is important to know that AHCCCS will not provide reimbursement for its enrollees for any services provided by individuals or groups that are not AHCCCS providers.
Please note that insurance companies typically require individual therapy sessions and group therapy sessions to be scheduled on different days. This policy helps to avoid any conflicts and ensures that you receive the full benefits available under your plan. If you have any questions, please contact your insurance company.
