Thursday, October 4, 2012

Insurance coverage for ED treatment

I see many an article, even a blog post, on insurance coverage for eating disorders and how poorly treatment is covered. I could write probably a more professional, appropriate post on this, but honestly, I'm not in the mood for such niceties. Below is the reality of being an eating disorder provider:

There's a young woman I care deeply for who is soon likely to die of her eating disorder. Now, certainly in the past she has had treatment and she has relapsed by making choices that were not consistent with her recovery. But, regardless, right now, her eating disorder is severe. Her body is shutting down, and she is going to die without expert intervention. She is currently in setting that is not able to manage her ED symptoms. Her insurance company is taking the "one program fits all approach" and refusing to give her any options for a treatment setting.

Mind you, this young woman is willing to go to treatment, she has signed herself into the current setting, she has remained in treatment without walking out. She is voluntary, and she is begging her insurance for options. The insurance company has heard from me, the patient, the family, the current setting, and we are all singing the same tune: Send this young woman to Program X, a program that is not that far away. They were supposed to have an answer last week, yet this week, she remains without any options, dying in her current setting.

I am irate. To worsen the story, this is the SECOND insurance company I have had to battle in this way for this patient. The previous company said, "She's a terminal case. She should just go to jail; that is a better setting for her." They refused coverage, I fought them. Let's just say they don't like me much anymore and I'm no longer authorized to see their ED patients. I will fight this second insurance company the same way. No amount of money from an insurance company will stop me from standing up to them to try to save this young woman's life.

I witness the emotional detachment others can demonstrate in these situations. Clearly, the insurance company is not seeing this young woman as a person. But, dammit, I know this young woman, she is not just a number, a paycheck, someone who chose this disorder. Until insurance companies, and even non-specialized providers better understand these disorders, we will lose patients. Insurance companies should not "be in bed" with one specific program and refuse to authorize other programs; that is just wrong. Not every patient will like me as his/her therapist, so there are multiple therapists to choose from; so why would they assume one program can serve all their members with eating disorders. This all makes me so angry. I know this young woman, and she does not deserve to die as a result of a breakdown of this system. She deserves one more shot at expert treatment. She deserve me continuing to fight, so I will.

At what point will people....providers, insurance companies, patients themselves....understand these disorders are lethal. They are not to be toyed with, brushed off, denied.

Fight your insurance companies. Hit them with more paper and more phone calls than they know what to do with. They are trying to wait you out, thinking you will back down; don't let it happen. Yes, they are a business, so they must be about the bottom line. But they also are a service industry, and they are serving you. You are paying their salaries. So, fight them. Please.


  1. The first time I went to CFC in 1999, our insurance would have nothing to do with eating disorder treatment. They would pay for medical complications only, which is pretty ironic because if they would have just paid for therapy in the first place, I might not have needed medical hospitalization and countless doctor visits that probably cost them more in the long run. When I went back to CFC in 2009 our insurance (different company) was actually very helpful and at one point I was even secretly hoping they would cut me off so I could go home sooner.

    It seems like insurance companies have come a long way as far as treatment goes, but clearly there is room for them to do a lot better. Another thing that frustrates me is seeing patients denied coverage or having their coverage cut short because of weight. It's like the insurance companies think weight restoration magically cures the e.d.

  2. You are absolutely correct regarding the flaws in insurance companies seeing weight gain as reason for discharge. As a provider, it always creates some weird thought process of "should we figure out how to keep 'em sick so we can keep 'em long enough to help 'em get well." Of course, we can never follow through on that thought process, but that is the irony that exists in ED treatment.

    It is my understanding that the DSM-V, coming out sometime soon-ish, removes the weight criteria, so that the insurance companies cannot rely on that as much. I hope that ends up helping.