It's been awhile since I've worked inpatient (primarily because I hate this crap), but the lore that was passed down was that it's harder to get prior authorization for the BPD diagnosis (or any PD diagnosis for that matter, given the number of sociopaths and narcissists we saw). That may be different with parity laws under AHA (or in California), but as a result, there was an epidemic of mood disorder NOS (not particularly helpful, maybe a little negligent, but fallsing short of malpractice or fraud).
I'd imagine the insurance logic for denying days to someone diagnosed with SI or even attempt is that BPD patients will have chronic SI. We almost had a patient rejected because they were a health professional, and they would know that their SA would not be significantly lethal to kill them (ignoring the events and affect leading up to their attempt).
Ultimately, the rationale for admitting a patient for BPD is to repair or put in place outpatient resources while the patient reconstitutes themselves, maybe diagnostic clarification if there are medical, substance or micro-psychotic elements to the presentation. It'd be great if the insurance just put the $10,000, or whatever the cost of admissions, to an outpatient service (all of a sudden, they would be our favorite patient). Of course, it would be a little too easy to game that system...
