One of the most elusive resources in treating eating disorders is adequate insurance coverage. You may have found yourself in lengthy appeals processed with an insurance company after a request for appropriate coverage was denied. You're not alone. While the discussions continue back and forth, those with eating disorders may suffer. In fact, some believe that the lack of available insurance for eating disorders contributes to related high mortality rates.
But there are resources you can employ to get the most comprehensive insurance coverage available through your policy. The Mental Health Parity Act of 2008 (see below) has made it easier for some. The trick is knowing how to jump through the right hoops.
Eating Disorders and Insurance: Obstacles to Coverage
There are plenty of hurdles to getting insurance payment for an eating disorder. First, you need to have insurance in the first place. Most insurance comes through employers as part of group plans. If you aren't employed by such an employer (or your family member isn't), getting insurance isn't always easy. Many don't get insurance because they already have risky health profiles, and others simply choose to avoid the expense. Still, others who seek insurance for themselves don't qualify for the better health insurance programs in their states. The coverage they can get may be poor, expensive, or both.
Even with an insurance policy present, though, there are requirements for you to be reimbursed for eating disorder-related expenses. A clinician must give an eating disorder diagnosis -- in particular, anorexia nervosa or bulimia nervosa. With a diagnosis in place, you or your treatment provider can submit insurance claims.
But ultimately, your insurance company decides what treatments are "medically necessary" for a patient with an eating disorder. You may have a treatment plan that includes residential treatment, while the insurance company finds that only outpatient treatment is medically necessary. Some insurance companies only authorize payment for a stronger level of treatment when a person's medical condition reaches a critical point -- and this critical point may be different than what is recommended by your treatment team. So, it's not uncommon for an initial insurance claim to be returned with payment denied. When this happens, you can still take action. More on arguing for the coverage you need below.
Levels of Eating Disorder Treatment
Here's an example of an insurance company tangle:
Suppose you're seeking insurance payment for treatment of anorexia nervosa, but the insurance company only approves payment when the disorder has progressed to a dangerous stage. Perhaps a doctor asserts that your life is in danger and that you require a hospital stay to avoid cardiac arrest -- and finally, the insurance company authorizes payment.
If you can't afford or qualify for more comprehensive coverage, this may be the first treatment that gets approved by your insurance company. By this time, the eating disorder is more well-established, gaining momentum through your ongoing daily habits and rituals. The eating disorder may be harder to treat in the long run because of the treatment delay as you wait for some kind of payment.
Limited Insurance Payment Authorizations for Eating Disorders
And still another problem:
Let's say that you have insurance coverage that pays at the beginning of treatment at an eating disorder treatment center. You then learn, though, that it will only pay for the first ten days of your stay. Your treatment plan says that you should stay for six weeks. Given that a treatment center's cost per month can range into the tens of thousands of dollars, it's clear why many families must take out second home mortgages to pay for their loved ones' treatment.
A treatment plan may include outpatient therapy, residential care, inpatient treatment, hospital care, support from a dietitian, medications or other options. Insurance providers can draw the line in seemingly arbitrary and confusing places, disallowing parts of the treatment you seek.
How Might the Start of Treatment Look?
Who's on an Eating Disorder Treatment Team?
Why Insurance Companies Are Reluctant to Cover Eating Disorders
Eating disorder treatment is often long-term (possibly covering several years), which means that it can cost an insurance company a great deal to cover any given case. Insurance providers may state that they aren't convinced that longer hospital stays and longer treatment plans are more helpful than short ones, so they tighten the purse strings when long-term care is requested.
Another reason for the reluctance of insurance companies to pay is completely legitimate: They're looking to weed out attempts at insurance fraud. Insurance companies want to know that they're paying for claims on genuine problems.
Do Insurance Companies Forget Hidden Eating Disorder Costs?
Insurance companies usually have pretty advanced data on whether their coverage is going to be financially beneficial to them or not. But do they take into account the emotional fallout from a child who is in consistently poor mental and physical health from an eating disorder, however? Eating disorders are connected with a number of other mental issues, including depression and anxiety. If depression, for example, could be avoided, it would benefit everyone. Health insurance covers treatment for depression more often, so avoiding it may save money for insurance providers.
Parents of children with health issues, certainly including eating disorders, often have marital problems. This can lead to still more mental stress for the child. The cost to insurance companies is even higher if, as is often the case, they also cover the parents who are disrupted by the problem.
