Implications of "dysthymia" diagnosis?

March 2, 2012 9:01 AM

I had an introductory meeting with a therapist to seek some help regarding gender identity issues, and on his bill, in addition to the DSM code for gender dysphoria, he has diagnosed me with 300.4, "dysthymic disorder". What implications are there if I submit this bill to my insurance provider?

My health plan covers mental health services, but the therapist is an out-of-network provider.

I think I have a good handle on security clearance implications (pretty sure that simply showing up for the session requires me to disclose it), but I wanted to make sure I haven't missed anything else.

Also, the introductory meeting didn't go very well (he actually had no experience with gender identity issues, despite being referred by someone who did but wasn't taking new patients), so I'm in the process of trying to find a different therapist.

posted by TranSubstantial to Health & Fitness (6 answers total)

Dysmthia is kind of a "low-grade" depression, as I understand it.

I would imagine it's one of the more common things that show up on a mental health bill. I really wouldn't worry too much about it, but IANA mental health provider/insurance/HR person.

Good luck in finding a better therapist - hang in there!
posted by pantarei70 at 9:23 AM on March 2, 2012 [1 favorite]

I've always understood dysthymia to be a fancy word for "unhappy," but I think pantarei70's take on it is more accurate. It is not a diagnosis that your insurance company is likely to question or refuse to pay for. It's very, very common.

This is not meant to diminish your feelings or issues in any way, mind. It isn't that dysthymia isn't important or is easy to deal with. But lots and lots of people have this diagnosis.

I am an insurance person, but I don't work for your health insurer.
posted by That's Numberwang! at 9:36 AM on March 2, 2012

Sorry your first appointment didn't go well. Best of luck with the next one.

In my understanding, as the law currently stands insurers in most states can deny coverage or set rates based on your medical history (notable exceptions include NY, MA, NJ, ME) including psychiatric/psychological diagnoses. Insurers do share health history information with each other for the purpose of setting rates and approving/denying coverage. This will only be relevant to you if you seek to buy an individual (or perhaps, small group) insurance policy. (Large group policies avoid these issues.) The new federal health reform law will change this in 2014, assuming it stands up in court. Assuming it is fully enacted, it will forbid insurers from discriminating on the basis of health history.

However, I don't know that dysthymic disorder is any more of a black mark on your record (from an insurer's standpoint) than gender dysphoria. It's not a serious disorder, as others have remarked. Furthermore, I believe you may be asked to report any diagnoses yourself if you apply for an individual policy, regardless of whether you tell you current insurer. (I don't have any direct experience of this because I've only applied for insurance in community-rated states. Can someone else confirm this?)

In sum, it is possible, depending on your state of residence (I'm assuming you're in the U.S. here), employment status, decisions from the Supreme Court, and other miscellaneous factors that are even more difficult to forsee that you could have more difficulty getting insurance if you submit this bill to your insurer. That said, it probably doesn't matter. Hopefully, the Supreme Court will be good and we'll never have to think about trying to keep secrets from our insurance companies again.
posted by reren at 9:50 AM on March 2, 2012

I thought at first that my therapist gave me a diagnosis of dysthymia just because it was a diagnosis that insurance is willing to accept without raising red flags. She spent a Lot of time making sure my insurance would cover (part of) our sessions.

Years later and better I realized she was right, I Was suffering from dysthymic disorder in that I was unhappy with how my life was going, and therapy helped with that. Insurance never argued about the diagnosis, and it was never a problem (but I've not tried to get individual insurance since). Best of luck finding the therapist for you!
posted by ldthomps at 10:19 AM on March 2, 2012

From a private-practitioner's standpoint, it's basically one of the diagnoses that insurance companies deem worthy of mental health coverage, while still being a relatively non-stigmatizing form of depression.
posted by so_gracefully at 10:58 AM on March 2, 2012 [1 favorite]

Being self-employed, I've had to apply for insurance a lot over the years. I can confirm that every time I've applied for individual insurance (both health, life, and disability), one of the questions I've always been asked is along the lines of "Have you ever been treated for or diagnosed for depression?" Saying yes usually puts some points against you, especially for health or disability insurance. I have no idea if Dysmthia would classify as depression in that instance.
posted by ninjakins at 11:03 AM on March 2, 2012 [1 favorite]