I have heard that some mental health diagnoses are reimbursable by insurance and some are not? Does anyone know which ones are and which ones aren't? For example, I have heard that PDs are not reimbursable, but I don't know if this is true.

I know the clinician knows which diagnoses are reimbursable and so knows which to list on the insurance form. But I am curious to know too.

For example, I go to a PNP and she puts down on my insurance form, "Major Depressive Disorder, Recurrent." However, I am not depressed. But I guess this is a good, reimbursable diagnosis, perhaps? I see her for ADHD and have two prescriptions for this. If she put down ADHD on the insurance form, would she not get reimbursed? Or perhaps she is doing this for my sake--there is more of a stigma associated with ADHD perhaps, than with MDD?

When I went to see a family therapist with my daughter, he billed to my insurance, just for me. My daughter was never listed as a patient. I think this is because my insurance only reimburses for individual therapy. The diagnosis he gave was "Adjustment Disorder," which as I understand it, is just about the most mild diagnosis one can have. I like that insurance will reimburse for this.

My daughter also sees a therapist, who we pay out of pocket, but her therapist said that if we did go through insurance, she would list "Adjustment Disorder" as the diagnosis as this was the most benign.

Has anyone ever been given a mental health diagnosis that was turned down by insurance? (I am currently facing this issue with a physical health diagnosis that my insurance will not reimburse for--TMJ disorder.)