Navigating Insurance Coverage for Eating Disorder Treatment Doesn’t Have to Be a Nuisance
One of the biggest barriers to treatment for people with eating disorders is cost. Some residential treatment programs can cost upwards of $30,000 per month. Although research shows that early intervention and evidence-based care are essential for recovery, insurance protocols can sometimes make it difficult to receive the best care indicated. When you are faced with an eating disorder diagnosis that requires access to treatment, where do you begin?
Talking to Your Insurance Company
Once you receive a diagnosis and have been counseled on the kind of treatment you’ll need, it is time to contact the insurance company. This can be a daunting task, but if you know what to ask you can make the call with confidence. Here are some tips on how to obtain a snapshot of your insurance benefits:
- Ask your insurance company to provide you with information regarding in-network benefits and out-of-network benefits for your plan. Each will have a different deductible and out of pocket amount. Some plans don’t offer out-of-network benefits, in which case you would be paying out of pocket for treatment services that are not in your insurance plan’s network.
- Do you have mental health benefits? Some plans don’t offer this provision. If you have a treatment program or provider chosen already, ask them for the service codes used when submitting claims to determine if those services are covered by your plan.
- Is the treatment center or provider recommended for your care in-network? Does your plan cover residential and partial hospitalization services?
If you are struggling with this arduous process, or if you find that your insurance plan is not sufficient to cover the treatment you need, enlist the help of your employer’s personnel department, contact local representatives, or contact an attorney. Although this process can indeed feel lonely and isolating, there are many advocates waiting to help you get the care you need.
What if I Don’t Have Insurance?
If you have Medicaid or Medicare, know that some hospitals and treatment programs will accept your plan. It can be difficult to find providers in these centers who specialize in eating disorders. If you have no insurance coverage and no financial resources, treatment is hard to find. Some outpatient providers offer sliding scale fees, and student health centers and medical schools can offer low cost treatment. There are also research programs that offer treatment in exchange for participation in eating disorder research. Check local universities for information on programs like these.
There are also scholarship funds available for people who cannot afford treatment:
Manna Fund, www.mannafund.org
The Project Heal, www.theprojectheal.org
Eating Disorder Recovery Support, www.edrs.net
Andrea’s Voice, www.andreasvoice.org
I Have Insurance but Treatment Wasn’t Covered
There are many reasons why insurance companies terminate treatment coverage early or don’t cover treatment at all. Despite the clear evidence that eating disorders are life-threatening illnesses with both physical and psychological components, coverage for treatment is not always adequate. For example, when a person with anorexia reaches their goal weight, the insurance company may deny further coverage. Despite the fact that recovery is just beginning and much more work needs to be done, some insurance plans focus on the weight restoration as the cure. When adequate treatment is not offered, relapse can occur quickly, possibly requiring a return to inpatient. This is why so many advocacy efforts focus on education- for the public, health care providers, and insurance companies.
Enlist a care manager at your insurance company to advocate for your case. Ask your providers for help. Write letters and find an attorney if necessary. You are not alone.
The following is a list of resources for insurance issues:
National Eating Disorders Association. Understanding Insurance Issues for Eating Disorders Treatment.
Eating Disorder Referral and Information Center. Insurance Coverage for Eating Disorders.
Eating Disorders Coalition. Understanding Parity and Insurance.
National Association of Anorexia Nervosa and Associated Disorders. Insurance Issues.