Insurance Coverage and DSM Diagnoses

Insurance Coverage and DSM Diagnoses

DSM stands for the Diagnostic and Statistical Manual of Mental Disorders and is the standard classification of mental health disorders used by psychiatric professionals in the United States. The manual provides the diagnostic classification, diagnostic criteria sets, and descriptive text that are used by several different professionals in the health care industry. This manual allows every professional to be on the same page when dealing with the multiple facets of diagnosing and treating mental health illnesses.

The DSM sets the framework for determining whether an insurance agency or institution will provide coverage for treatment. The DSM has a diagnostic classification list of all the mental health disorders that can be clinically diagnosed, and each disorder included in the manual has its own diagnostic code that is used by a physician, health care professional, insurance agency, etc. While every insurance agency differs with their policies and coverage plans, most will require a DSM diagnosis before any insurance coverage will be applicable.

What Criteria Determines a DSM Diagnosis?

While the DSM can be a useful tool, it relies on using symptoms to diagnose a condition. Unlike other medical conditions or neurological disorders, mental health disorders are not diagnosed by biological examinations, such as blood tests, etc. Mental health disorders are diagnosed by the symptoms and conditions that present themselves under a particular diagnosis in the DSM. The problem with this diagnosis pathway is that there are an infinite number of causal sources and factors that contribute to mental health disorders which may not be the same for everyone.

Not every individual experiences the same symptoms, and many individuals do not notice every present symptom that is required to make a clinical diagnosis, according to DSM standards. People are often misdiagnosed or undiagnosed, which can limit coverage from an insurance provider.

Having such a black-and-white diagnostic manual to address such a gray area causes many issues. Even more concerning is the limited coverage insurance companies will offer, even when a DSM diagnoses is provided. Mental health disorders are still not given the attention they deserve, considering their severity and prevalence among the population. In most cases, insurance coverage is provided for medicinal treatments only, offering limited options for long-term, non-addictive treatment.

In today’s society, people want to get better and get better fast. If a medication is covered by insurance, most people are going to take that route, expecting the drug to be a quick and simple solution. In reality, medications can cause several repercussions, aggravating mental health conditions, altering the brain, causing chemical dependency and symptoms of withdrawal and so on. This is especially harmful in instances where individuals are misdiagnosed or suffering from multiple health conditions with misconstrued symptoms. Unfortunately, when long-term, alternate treatment options are not converted under insurance, people are pushed into using short-term medicinal treatment for long-term mental problems.