Mental Health Parity Act Evens the Playing Field...For Some
Until late 2008, coverage for mental health concerns was not required to match coverage for problems that are strictly physical. This has changed for certain policyholders. The Mental Health Parity Act of 2008 is now in place at the federal level. This law requires employer-provided group insurance policies for 50 or more employees to cover mental and addictive issues as they cover other health problems -- a major triumph for individuals and families who are trying to overcome eating disorders.
But it's not quite as comprehensive as it seems. The Mental Health Parity Act does not require the policies to cover mental health at all -- just that any mental health coverage offered must be equal in dollar amount to coverage for purely medical issues. Also, policies that do offer mental health benefits don't have to cover every mental health issue. So eating disorders could get left out.
The technicalities of the Parity Act underscore that it's still up to you to understand your policy's coverage. You may need to know the ins and outs of the company's appeals process, too.
Making the Case for Better Eating Disorders Insurance Payment
The most important thing to remember is that initial denials from your insurance company are not the end of the line. You can appeal such decisions, arguing (kindly) that they be reconsidered. Several resources are available to strengthen your requests for insurance help.
- The American Psychiatric Association's eating disorder treatment guidelines: This document includes support for longer-term care, using multiple clinicians from several disciplines, and cautions against discharging too early from vital hospital stays. Be aware of the guidelines' recommendations for appropriate care levels. A letter to your insurance company stating that they are going against professional recommendations can be very helpful.
- Anna Westin Foundation: There's very little I could tell you about getting support that you can't learn from an excellent description of how to be persistent at the website for the Anna Westin Foundation, named for a young woman who died of an eating disorder in the absence of a response from her insurance company. What I like about the foundation's suggestions is that they urge definitive action. They include concrete advice on finding out how your insurance company makes decisions and uses this to your advantage.
- NEDA's Insurance Advice: Also, be sure to page through the Insurance Issues Document linked from the National Eating Disorder Association's Eating Disorders Survival Guide. In particular, there are numerous examples of letters of appeal that you can use in communication with your insurance company.
- Statistical support for treatment from Dr. Margo Maine: This information, also at the NEDA website, gives well-organized and compelling research evidence that backs the APA's guidelines.
Sources:
DeAngelis T. Pressing for better insurance coverage for eating disorders. At apa.org. Accessed 2 August 2008.
Maine M. Securing eating disorders treatment: Ammunition for arguments with third parties. At nationaleatingdisorders.org. Accessed 7 August 2008.
Westin K and Westin M. Insurance coverage. At annawestinfoundation.org. Accessed 6 August 2008.
