Below you will find information on Single Case Agreements (SCA)

The DBT-Linehan Board of Certification™ (DBT-LBC™) is committed to helping all individuals receive quality DBT services regardless of financial situation.  We understand that the process of identifying high fidelity providers and programs who accept insurance can be an extremely difficult task, in the midst of what is already an incredibly overwhelming time.  If you are unable to find an in-network provider and/or program or are struggling to assess whether a provider is providing DBT as designed and researched, we have created the following to help you in that process.  There are clinicians and programs that provide quality DBT that may not be certified by DBT-LBC™, but those that have been certified by DBT-LBC™ have met certain high certification assessment standards and that often helps in getting your insurance company to agree to cover the treatment.  If there are no DBT-LBC™ certified clinicians or programs within your physical vicinity, we encourage you to make sure that any clinicians providing comprehensive DBT meet all the other criteria stated in this document before proceeding with getting an SCA.

Many clients have been able to get a “Single Case Exception” or a “Single Case Agreement” for DBT 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 the same cost as in-network therapy for the subscriber.

Your insurance company may tell you that they have a specialist on their panel/in-network who can meet your needs. However, it is very unlikely in most situations, that you will actually be able to find a DBT-LBC™ certified clinician (or even a trained DBT therapist) or certified program who is in-network.

What we suggest is that you call any therapist or program who your insurance company says provides in-network DBT and ask questions about the treatment provided. Below you will find the components of a comprehensive DBT program:

Comprehensive DBT consists of four components:

  1. Weekly individual therapy (typically 45-60 minutes) with a DBT-trained clinician, (a minimum of 40 DBT specific hours of training) and preferably a DBT-LBC™ certified clinician or a clinician within the DBT-LBC™ certified program. The session is structured using a Diary Card.
  2. Weekly DBT skills training group (2 hours) that is didactic in nature and not a process group. Skills training requires that both teaching of new material AND a review of assigned weekly homework is conducted. Research indicates that outcomes for adult clients are best if they complete 2 full cycles of the program’s skills training curriculum. For adolescent DBT, the group is typically a Multi-Family Group where the client and caregivers attend together (2 hours).
  3. In between session phone coaching is needed to help the client use skills in daily life and avoid higher levels of care.
  4. Clinician Consultation Team meeting where DBT therapists participate in a weekly consultation team meeting with only other DBT trained therapists.

If you find that the therapists or program whose names you have been given by your insurance company are not DBT therapists, go back to your insurance company and ask for them if they will authorize out-of-network treatment under a single case exception or single case agreement.  Some states have laws that will help support you in these requests. Our clients tell us that they are most successful when they appeal and act assertively.  Do not expect to get an immediate “yes” or approval for your request.  It may take going up the chain a bit to find someone who is familiar with DBT.

Single Case Agreement (SCA): Below is a script for you to use when calling your insurance:

First say, “I would like to request a Single Case Agreement/Exception to see an Out-of-Network provider and/or program who is certified by Dialectical Behavior Therapy-Linehan Board of Certification™ (or specializes in Dialectical Behavior Therapy).” (It is best to say the whole name of Dialectical Behavior Therapy instead of DBT because insurance companies often think people are saying CBT).

Second say, “I have tried to find a Dialectical Behavior Therapy- Linehan Board of Certification™ program/clinician who is in-network with (name of insurance plan) and have not found any.  I cannot afford to see an out-of-network provider without a single case agreement because I do not have out of network benefits/I have out of network benefits with a high deductible and co-insurance.”

This may be the point where the insurance company gives you names of providers in-network who “do DBT.”  You will then need to call those names and ask the questions that were discussed above to assess whether they really are trained DBT clinicians providing DBT therapy.  After you call the names given to you and you do not find a DBT clinician in-network, call the insurance company back and continue with the following:

Third say, “I have called the clinicians and programs that you provided to me on (say the date of your initial call) and upon speaking with them discovered that they are not certified by DBT-Linehan Board of Certification™ or trained in Dialectical Behavior Therapy and/or do not follow the researched and evidence-based model of Dialectical Behavior Therapy in their practices.”

Fourth say, “Through my own research I found a clinician and/or program who is certified by the DBT-Linehan Board of Certification™.  I have asked if (name of clinician referred to in previous statement) will consider a single case agreement and they have said yes. What is the next step I need to take?”

Once you start the process for getting a single case agreement/exception you may be asked by the insurance company to “justify” why you need this specialized treatment in order for them to agree to cover it.  Many insurance companies will require that you have the symptoms or behaviors associated with Borderline Personality Disorder, emotional dysregulation and/or behavioral dysregulation (e.g. self-harm, suicidal behavior and thoughts, psychiatric hospitalizations, etc.).  That is because DBT has been shown by research to reduce these issues and reduce the need for other higher levels of care (e.g. partial hospital).  As a result, DBT is a therapy shown to reduce overall expenses for the insurance companies in the long-term. This cost reduction has been confirmed by research on ADHERENT DBT PROGRAMS ONLY that deliver all four components discussed above in a manner that is consistent with the design and research of the treatment.

Many insurance company representatives are not familiar with different types of therapies and do not know the difference between them.  If you are running into roadblocks with a particular insurance company representative it may help to say the following, “Is there a representative or supervisor I can speak with who has specific experience and knowledge of Dialectical Behavior Therapy?”  It is common that once a person knowledgeable about the treatment modality becomes part of the process that things start moving along more smoothly.

Please know that the process of getting an SCA differs widely between states and from insurance company to insurance company. If you are having difficulties or have questions after trying these steps, ask a DBT-LBC™ Certified provider in your state or contact DBT-LBC™ for assistance in identifying a provider who might be able to answer your questions.

For a printable version of the script, please click one of these links: Brief SCA Script or Full SCA Script

The legislative committee of the DBT-LBC™ would like to share our greatest appreciation for those organizations and clinicians who have gone before us in helping to support patients and their families in getting Single Case Agreements for DBT!  These include Emotions Matter Inc. [] and their publication “Utilizing Single Case Agreements to Access Treatment for Borderline Personality Disorder: A Strategy to Support Health Care Consumers and Clinicians” (2017), and Judi Sprei, PhD, Britt Rathbone, LCSW-C, Brian Corrado, PsyD of the DBT Metro Consortium []