According to the National Institute of Mental Health, up to 10 million people in the United States suffer from some sort of eating disorder at any given time. However, many insurance companies will not cover treatment of the disease. If they do provide coverage, they only partially cover it. One of the main reasons for this problem is the fact there is no legislation in place at the federal level helping to classify eating disorders as a medical condition that requires treatment. Most insurance companies classify eating disorders as "behavioral choices," which gets them off the hook in most states. Certain states have legislation in place, but it is not standardized and patients often have to fight the insurance companies for coverage. Here are things that you can do to get insurance involved in you or your loved one’s case.
Most insurance companies will cover the costs associated with treating physical symptoms related to the disease. For example, they will cover costs associated with the body breaking down after a prolonged battle with bulimia or anorexia nervosa, everything from heart and kidney failure to high blood pressure and esophageal damage. However, they will not provide coverage to treat the underlying mental disorders that lead to the eating disorders and thus to the physical symptoms. The sad irony is that the physical symptoms often get to the point where the patient needs acute, emergency medical intervention that the insurance pays for, but at a greater cost than the mental health aspect would to prevent it from getting to that point.
Treatment facilities can often work with your insurance company to determine coverage and will often help work with your insurance company to get reimbursement. If the insurance company refuses to cover the treatment, you have the option to appeal the decision. Some insurance companies that do cover inpatient treatment require that you use a facility within a certain geographical boundary. If your state or community does not have an appropriate center, the insurance company may refuse to cover the treatment.
Remember, just because your insurance company approves you or a loved one for treatment coverage, do not expect the battle to be over. Insurance companies will work hard to discharge patients as soon as possible. They will go after the facility daily and will request the patient be discharged even with minimal progress. It is important to be a strong advocate in order to help the patient, even yourself, get through this process.
