Paying for Treatment
Eating Disorder Treatment and Insurance Issues
Dealing with, and seeking treatment for an eating disorder can be emotionally and financially devastating. When your health insurance company gives you a hard time, or when it denies payment for benefits, matters only go from bad to worse.
The American Psychiatric Association's Practice Guidelines include residential treatment as an essential step in the spectrum of treatment for eating disorders, falling between inpatient hospital care and outpatient care. For many clients, residential treatment is the most appropriate and effective level of care for treatment of their eating disorder and related conditions. Professionals involved in the treatment of eating disorders have produced concrete evidence that residential care treatment is optimal to prevent relapse and promote healing because it addresses both medical and psychological issues. Some insurers ignore this accepted standard of care, however, providing coverage only for hospitalization or outpatient care.
What can you do?
Familiarize yourself with your insurance policy or health benefit plan. Obtain a copy from your employer or insurance company if you don’t have one.
Understand the insurance policy’s coverage for treatment at an in-network facility versus an out-of-network facility.
Ask your insurance company for a list of in-network treatment facilities.
If the insurance company has no in-network facilities in your area or state, ask your insurance company for a single case agreement with your preferred treatment facility in your area.
Document that the treatment is medically necessary by providing your doctor’s written support, your own letter describing your need for treatment, and if available, letters of support from family members, friends, and/or co-workers.
Document what forms of therapy and treatment you have exhausted by submitting copies of all treatment records to the insurance company.
Ensure that your facility communicates with the insurance company in writing and retains records of correspondence.
Keep records of all out-of-pocket expenses for future reimbursement.
Find out if your state has a Mental Health Parity Law. The National Alliance on Mental Illness has a chart outlining the mental health parity laws for each state.
Obtain a copy of the treatment facility’s license to determine if it qualifies as a hospital, skilled nursing facility, congregate living facility, or other health facility license through the state.
Seeking treatment for an eating disorder can be overwhelming, intimidating, daunting and confusing. It’s imperative that you become aware of the treatment that is available to you, and the necessary steps for receiving this treatment through your insurance company. In order to obtain residential care, policyholders frequently must sue their health plan or insurer to pay for treatment. If you and your family feel that this is the next step in order to secure coverage for treatment, contact an attorney with expertise in this area of law.
Lisa Kantor, Esq
Kantor & Kantor, LLP