Q: “I’ve heard insurance plans only pay for Cognitive Behavioral Therapy (CBT).  How can I document my psychodynamic interventions so that health plans will pay for the session?” 

A: This is an issue faced by most therapists, since most clinicians utilize psychodynamic techniques to some degree in their practice.

The good news is that, contrary to popular belief, insurance companies DON’T only reimburse for CBT.

However, they DO require therapy to be evidence-based and medically necessary (see my article here).  Psychodynamic sessions with the sole aim of self-understanding or personal growth would not be covered by medical insurance.  And health plans often feel that one session per week is all that is necessary unless the client is in crisis.

But if you feel your client truly has a diagnosis (typically more than just a Z-code), and if your treatment is at least partially aimed at reducing the symptoms of that diagnosis, most psychodynamic techniques should be covered by insurance.

This means techniques such as interpretations, identifying defense mechanisms and projections, working with transference and countertransference, using free association, analyzing dreams, trauma work, healing the inner child, and working with family of origin or childhood issues could potentially all be approved by an insurance plan.

But here’s the catch:  If your client is using insurance, it is ESSENTIAL that you explain in your session notes how these techniques are being used toward reducing the client’s current symptoms.  The connection between your technique and the “here and now” symptoms should be in each note, so it is clear why you are doing what you are doing.  Also, progress must be documented toward reducing impairment.  While insurance plans don’t typically see these notes, they can request your notes before or after a claim is paid, and they will look for the documented medical necessity of your care.

Two Tips

When writing your intervention,

• Document the intervention or technique you used. I recommend that your session notes reflect a minimum of 3 of your strongest interventions per 45+-minute session.
• State your goal in using the intervention. That is, connect the technique to client’s CURRENT symptoms or dysfunctional behavior.  It should be clear why you did this intervention, and why the insurance plan should pay for it

Let’s Play, “How Do You Describe This Intervention?”

Let’s look at four examples of sessions, comparing “not-so-great session notes” with “better notes:”

Want lots more examples?  Download my FREE Intervention Documentation Cheat Sheet!

I’ve created a cheat sheet that can save time and reduce stress — just enter your name and email into the form below and you will be able to immediately download the free document.

Would you be nervous if a health plan asked to see your notes?  Do you know what insurance plans look for when they audit charts?  Watch my webinar “What’s Missing From Your Charts: Writing Great Notes” at www.theinsurancemaze.com/store