Insurance Billing

We are currently not on any insurance panels, and therefore do not usually bill health insurance companies. We generally require payment in advance or at time of service, and we can provide you a payment summary statement for you to submit to your insurance company. Many insurance companies will partially reimburse you for your DBT sessions. Check with your insurance company to verify how much they will reimburse you for your sessions at DBTCSD. The statements you receive include, if needed, the CPT and diagnosis codes required by your health insurer.

The primary CPT billing codes to verify are:

• Diagnostic Interview - 90791
• Individual Therapy (adults and adolescents) - 90834 (50-60 min), 90837 (90 min)
• Skills Group (adults and adolescents) - 90853
• Biofeedback - 90875 (30 min), 90876 (45 min)
• Couples Therapy - 90846 and 90847
• Family Therapy and Parent Training - 90846 and 90847

Occasionally, we are able to set up single-case agreements with the insurance company to pay the full cost of your sessions when we can make a convincing case for the medical necessity of DBT for the member and the lack of alternative accredited DBT programs in San Diego. Insurance companies are more likely to approve single-case agreements when the member informs them that standard DBT is the psychotherapy with the most scientific evidence for reducing overall treatment costs, because it substantially reduces suicidal behavior, psychiatric hospitalizations, and ER visits. Therefore, an insurance company is most likely to approve a single-case agreement when the member has had multiple prior psychiatric hospitalizations or ER visits and tells this to their insurance company.

Insurance companies will not pay for telephone calls, missed therapy groups, and late cancellation fees. Many insurance companies also will not pay for multiple non-group therapy sessions that you attend on the same day, DBT sessions you attend on the same day as sessions with psychiatrists or other therapists, or DBT sessions you attend on the same day as inpatient treatment. We require that you pay out-of-pocket the full fees incurred in these instances when your insurance company does not reimburse you.

If you would like us to help you get your insurance to cover DBT, please fill out our Insurance Information form. All information is required in order for your insurance company to speak to us about your coverage. Please type carefully, as errors will delay the process.

Responding to Denials

Follow these useful instructions

In most circumstances, you are required to first file a grievance regarding each issue/request with your health plan and participate in the process for 30 days before submitting a complaint to a government agency (DMHC or CDI). Contact your health plan's Member Services for details.
Department of Managed Health Care (DMHC) (888) 466-2219
California Department of Insurance (CDI) (800) 927-4357
The easiest way to find out which agency oversees your plan is to call the consumer hotline number for either agency and ask a representative.
Tell the DMHC or CDI if your insurance company has not met their obligations to pay for your treatment according to your plan or your single-case agreement.
If you were denied a single-case agreement, you may need to ask for an Independent Medical Review (IMR).

Laws and Regulations