Navigating Insurance Pushback in Bipolar Disorder Treatment Transcript

Psych Congress Network: How can providers better advocate for patients with bipolar disorder when their insurance provider won’t pay for a needed treatment?

Desiree Matthews, PMHNP-BC: Another instance I find providers having pushback from payers to cover treatments, prescription treatments, is for bipolar depression. We know that bipolar depression really responds to very few and select agents, and oftentimes payers will request for me to use a medication first that's generic, that's actually not FDA-approved for bipolar depression. So some tips and tricks for providers to get access to these agents that are approved for bipolar depression is number 1, making sure that on your prior authorization, or even on your appeal, you're coding it as bipolar depression. Very important to be as specific as possible. Number 2, asking the insurance company, telling them, "I need a product that has FDA approval and indication for bipolar depression. Because as we know, for many studies, not all atypical antipsychotics, for instance, are the same. Some are approved for mania and mixed episode, some are approved for maintenance and some are solely approved for bipolar depression." So if you're as specific as possible and requesting an FDA-approved product for bipolar depression, you'll generally get a positive outcome from the insurance company.