Understanding Insurance Issues For Eating Disorders
Navigating an insurance billing for eating disorders can be a nuisance if you do not know what to do or where to “touch.” One of the main obstacles to treatment for individuals with eating abnormalities is the cost of the treatment. Some residential treatment centers can cost up to $30,000 a month! This makes getting insurance reimbursement for people needing help with eating disorders very critical.
Now, while studies show that early diagnosis and evidence-based medical care approach are both critical for recovery, insurance regulations and guidelines in most cases make it almost impossible to receive the appropriate care needed. The treating clinical professionals
So, if you or your loved one is faced with this type of condition, where do you start? Sadly, these challenges sometimes include determining how to analyze your insurance plans to understand the treatment coverage that is ideal for you. Here are some aspects that you should know about insurance billing for disorders:
What type of eating disorders are covered by your insurance?
Many insurances have eating disorders cover benefits that technically cover these eating disorder diagnoses:
- Binge eating disorder
- Anorexia nervosa
- Bulimia Nervosa
- Avoidant/ restrictive intake disorder
- Any other specified eating or feeding disorder.
What will be deducted, and how much is it?
In most cases, once you make a phone call to the company, the admission department or the respective department will check your benefits. After the confirmation, you will be informed of any deductible that you are supposed to pay out of your pocket. This is usually the amount you are supposed to pay before an insurance company covers a claim. The specific amount sometimes varies depending on the insurance company as well as the plan.
For instance, if your deductible is $ 500 and treatment is billed at $ 250 daily, you would be responsible for covering the initial two days on your own. After you make the payments or meet the deductible, the insurance firm will cover the expenses 100 %. Some firms require policyholders to pay co-insurance. This is where you are responsible for paying a certain percentage of the entire insurance billing for eating disorders. This can range from 10 to 50 %.
What level of care is paid for?
In most cases, the level of care that insurance companies approve for is individual outpatient therapy. The best level, however, of behavioral healthcare is inpatient, then residential care, PHP (Partial Hospital program (PHP), and finally the IOP (intensive outpatient program). Note that, for you to access any of the above treatments, you must
- Have benefits under your plan for these levels of healthcare
- Meet the necessity, which is evaluated by the severity of symptoms, current weight, vital signs, and blood work results.
How long will the cover last?
This will depend on various factors. Has your condition improved? Is it deteriorating? Most insurances state in their “insurance billing for eating disorders” policy that you have unlimited days depending on medical necessity. Once you stop meeting the level of care required for a certain program, you will have to step down for a less intensive level of care.
For instance, you can be admitted into a residential program once you stabilize and no longer need critical care or you do not meet the clinical or medical criteria. Similarly, if you do not improve in that care, and your condition is worsening, you will be admitted to a better level of care, such as inpatient.
What if my insurance does not cover eating disorders?
There are a few things you can do depending on your personal and financial circumstances:
- Switch plans; This should be pretty straightforward for anybody whose current plan does not cover eating disorders. Not all insurance companies offer this, but some reliable ones do it as a reprieve for members from a high-cost treatment.
- Some non-profit organizations now partner with various treatment centers to provide financial help to those who cannot afford life-saving treatments. Look for one and ask for help.
It is important to understand these factors so that you can advocate to receive the right treatment. You are capable and strong enough to mastermind your future.