Insurance and Eating Disorders: Getting Coverage

Estimates show that in the United States over 20 million women and 10 million men suffer from an eating disorder (1). Furthermore, eating disorders have the highest mortality rate of any other mental illness. Of these, approximately 20% of individuals suffering from an eating disorder will have complications and die prematurely (2); this includes committing suicide as well as heart problems. Of these one in 10 individuals will receive treatment, and those who have access to care do not get the amount of care needed to continue treatment and are often sent home with no treatment plan (3). Relapse as well is a big issue.

Relapse

Some studies have shown relapse rates, for those suffering from Anorexia and Bulimia, can range from 30% at 6 months post discharge to 63% within 18 months. It’s also estimated that only 1/3 of the sufferers were eating disorder free one year after continual treatment (3). With relapse rates being so high, health insurance coverage is even more of a concern. Treatment is costly and out-of-pocket expenses through health insurance and Medicare/Medicaid may become excessive and add up.

Cost

Treatment costs in the United States can be very expensive. The average cost of stay can range from $500 dollars a day to $2,000 dollars per day (3). An average cost of a monthly inpatient stay can run upwards of $30,000. Health insurance companies, including Medicare and Medicaid, customarily do not like to cover the cost of treatment for eating disorders. So how does an individual to get treatment with limited financial resources?

Health Insurance Benefits: Getting the Coverage You Deserve

Traveling through the maze of insurance can at times be difficult. Some insurance companies are more reluctant to cover eating disorders, while others prove to be less problematic. Dealing with an eating disorder and the stress of getting insurance coverage is exhausting. Frequently insurers will only pay if the individual is displaying signs of medical complications, and are presenting signs of severe emaciation.

There are steps you can take to ensure that you are getting the coverage you deserve through your insurance company. While not all insurance companies operate the same way, and while some are harder to deal with, taking these steps can offer assistance:

  • Contact your insurance company, and find out what your benefits are. Discuss the necessity of treatment and even educate them on the severity of the eating disorder. It’s not uncommon for people to write a letter stressing the need for treatment and the options available. Unfortunately sometimes it does take effort to educate your insurance company.Health Insurance
  • If you don’t already have a copy of your insurance policy, ask for one. You are legally entitled to a copy upon request. This will spell out all of your benefits, or in some cases lack of benefits. If it’s difficult to understand the language of the policy, which is fairly common, make sure you call your insurance company in order to get clarity.
  • What if you’re still not getting the information you need? If your insurance is stating you have no eating disorder coverage? Write a letter. At this point, if the insurance company denies eating disorder coverage, you can appeal the decision.
  • Know the law. Educate yourself on the Mental Health Parity Act, specific to your state.
  • In some cases you may find an eating disorder program that’s not in-network, if this is the case it may take a few appeals or agreements to obtain it. This is known as a single case agreement.

Free Treatment Resources and Scholarship Programs

For individuals in financial need there are many free resources, particularly for those without sufficient health insurance coverage. Andrea’s Voice Foundation provides a list of some of these available resources, such as scholarships.

Resources for Seeking Out Eating Disorder Facilities

The Alliance for Eating Disorders has put together a comprehensive resource guide that list’s eating disorder facilities throughout the United States. It can give you information on insurance coverage, as well as if they take part with Medicare and/or Medicaid.

Insurance companies are notorious for rejecting eating disorder claims or coverage. Persistence is the key to getting the coverage you deserve. Many insurers refuse to treat an eating disorder equivalent to a mental disorder, even though required by law. Insurance companies continue to dictate what they will or will not cover. While new Federal mandates are being created there are still many gaps and loopholes that health insurance companies continue to use. Currently the Eating Disorders Coalition, which includes over 35 eating disorder organizations, is working with Members of Congress to ensure that insurance laws at the Federal and State levels are following proper guidelines that are already in place. Voices are starting to be heard, and this gives hope.

 

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Additional Resources:

Kantor and Kantor is a law firm that specializes in helping clients nationwide obtain insurance coverage for eating disorders. In addition to providing legal defense, they have developed numerous documents to help educate providers and patients of their rights. One such document is:

Seeking Legal Assistance for Treatment of an Eating Disorder: 4 Things You Should Know

Sources:

(1) NEDA Eating Disorder Statistics

(2) ANAD Statistics

(3) Eating Disorders Coalition

About The Author

This article was written by Ashley Janssen who lives near Washington DC. In February of 2014, after having anorexia for 17 years, she was hospitalized for her eating disorder. She now focuses her energy on the use of social networking as a tool to help sufferers of eating disorders connect with eating disorder facilities, therapists, nutritionists, and medical providers. You can contact Ashley on Twitter or Facebook.