Navigating Insurance Coverage in Eating Disorder Treatment

 

Written by CCTC Staff Writer

Navigating health insurance benefits is overwhelming for many people and families. You may struggle to find out what providers, conditions and treatments are covered and are unable to get the answers you need from your health insurance company. Not to mention the complexities many insurance companies have for covering any services related to behavioral health, often treated as a separate part of their coverage offered.

When it comes to eating disorders specifically, there are unfortunately some obstacles that people may face to receive the help they need and deserve. This often leaves people feeling hopeless and lost when it comes to making decisions about what type of care is appropriate and needed to treat their own or loved ones' eating disorder.

But, don't let this stop you from seeking the help you need. There are plenty of ways to prepare and create an arsenal of resources to work with your insurance company to get the coverage you deserve.

In this blog we will cover:

  • Why people do not receive eating disorder treatment

  • Common questions about health insurance coverage and eating disorders

  • Common terms to know

  • Questions to ask your insurance company 

  • Resources for seeking treatment without insurance

  • What to do if you are ready to take the first step 

Why people do not receive eating disorder treatment 

Eating disorders are among the deadliest mental illnesses, second only to opioid overdoses. 10,200 deaths every year are the direct result of an eating disorder - that is one death every 52 minutes. Despite these staggering statistics, insurance companies make it difficult and complicated for people to access proper care and treatment. While many recognize receiving eating disorder treatment is extremely important for themselves or their loved one, financial obstacles may prevent them from taking any steps toward seeking recovery support.

Only five in every fifty people with an eating disorder ever seek treatment, and four out of those five never receive the treatment they need to fully recover. With treatment, however, survival and success rates are high, with only two-three percent dying and about sixty percent recovering. 

For those without health insurance, treatment may feel impossible to access. For those with insurance, paying for treatment can be a battle as well. But, with or without insurance, there are numerous ways you can access or pay for eating disorder treatment. 

Common questions about health insurance coverage and eating disorders:


What types of eating disorders are typically covered by insurance?

There is a wide range of eating disorders that can be covered by health insurance, including anorexia nervosa, bulimia nervosa, binge eating disorder, and other specified feeding or eating disorders (OSFED). Most insurance companies utilize the Diagnostic and Statistical Manual of Mental Disorders, DSM-5, to categorize the different eating disorder diagnoses.

-How much does eating disorder treatment cost?

Treatment costs can vary drastically depending on the type of treatment needed, how long that care is accessed, and what type of benefits you have. Estimating this cost can be done once you have more information on the type of care recommended for you or your loved one.


What type of treatment may be covered?

There are five main levels of eating disorder treatment available. The type of treatment someone needs is determined by the severity of the eating disorder. Determining the right level of care will take into consideration the type and frequency of symptoms one is struggling with, if there are any co-occurring issues present that need attention, or if medical monitoring is necessary.

Outpatient Treatment: Lowest level of care, individuals who are medically stable. Flexible, part-time programming that involves therapy and counseling multiple times a week.

Intensive Outpatient Program (IOP): This level of care provides more structure with programming 3-7 days a week for a few hours a day. This allows patients to live at home while receiving daily group therapy, meal support and individual sessions.

Partial Hospitalization Program (PHP): This level of care is all-day programming 5-7 days a week providing similar offerings as IOP but with more supported hours.

Residential Treatment: Patients in a residential setting do not require intensive medical support, but may benefit from daily medical support from on-site nurses. This is a 24/7 program where individuals live on-site and are in a structured environment.

Inpatient Treatment: Inpatient treatment is for patients who are medically unstable and require medical intervention. Typically, once a patient is discharged from Inpatient, they will step down to a residential program or PHP.

Related: What Eating Disorder Treatment is Really Like


How do I find out what type of treatment they will cover?

Asking your insurance company for a copy of your plan to determine what level of treatment they will cover is a great first step. You can also request a list of outpatient providers and treatment facilities available in your network. Opting for in-network programs is the most cost-effective choice. You may also reach out directly to eating disorder treatment centers that you may be interested in to request a benefits check to determine how it may apply to that specific program.

Common terms to know

If it is your first time having to navigate your health insurance benefits in this manner, it can be overwhelming. Here are a list of terms that may be helpful to understand the meaning of while you discuss your options:

Deductible: A deductible is a fixed amount you are responsible to pay out of pocket before the insurance company will reimburse the provider.

In-Network Providers: Insurance companies contract with certain providers to be designated as "in-network" meaning they typically will cover all, or a certain amount, of the services received.

Co-Pay: Some insurance plans require the client to pay a certain amount of the providers fee. This co-pay would typically be collected at each session or appointment.

Pre-certification: Some insurance plans will require your provider to get a certification before they can provide certain types of treatment. If treatment is not pre-certified before services are rendered, your insurance company may deny paying the claim.

Out-of-Network Provider: An out-of-network provider is not a part of your network. This may result in higher costs, depending on what type of out-of-network benefits you have. If there are out-of-network benefits, the insurance company may provide partial reimbursement for the total cost of services.

Questions you should ask your insurance company when learning more about your policy and coverage

  • What type of eating disorder treatment does my plan cover?

  • Does my insurance plan cover psychotherapy sessions or mental health services?

  • Does my plan cover out-of-network services?

  • Is there a deductible I have to meet for coverage to begin?

  • Do I have a co-pay for sessions or groups?

  • What is the coinsurance? How much does the coinsurance cover?

  • Is there a maximum amount per session the insurance will cover for an out­-of-network provider?

  • How much time do I have to file a claim for out­-of-network services?

  • What is the process to get reimbursed for out­-of-network services?

  • If coverage is denied, what is the appeal process like? Is there a typical timeframe for these reviews?

Grants for eating disorder treatment

We know that accessing eating disorder treatment can be difficult for many. There are some non-profit treatment programs that provide either free treatment, scholarships, or income-based rates.

There are two organizations that offer grants to help pay for treatment including Project HEAL and Manna Fund. Some treatment centers and providers also offer their own grants and scholarships, so asking if a provider or someone they can refer you to offer grants or scholarships can be another positive step towards accessing care.

Taking the first step

At Central Coast Treatment Center we proudly participate with a variety of national and California-based insurance companies. This includes, but is not limited to, Aetna, Beacon, Anthem Blue Cross Blue Shield, United Healthcare, Magellan Health & Cigna. We are also happy to discuss the possibility of a Single Case Agreement in order to get you the care that you need. Our Admissions and Medical teams will work directly with your insurance provider to determine your individual eligibility and benefits so that you can access the appropriate care for your eating disorders as you move through your treatment and recovery process.

To begin the process of checking your benefits and seeing if treatment at Central Coast is right for you, please contact us today.

 
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