What I'm sad to report is that this remains a very real battle for individuals needing eating disorder treatment. There is movement on the national and state level to advocate for better coverage, but the progress is slow. I wanted to share a recent story to highlight this battle, and then provide some ideas of things you can do.
Over the past few months, a family has been battling their teenager's eating disorder at home. This teen had sought inpatient/residential treatment previously, and was discharged as soon as his benefits were exhausted. The parents could not afford the high costs of ongoing residential care on their own, which is true for most families. The only likely outcome came to fruition. The teenager relapsed and I met the family a few weeks later. The teen was admitted to the hospital, which began to fight the insurance company for ongoing benefits. I have never seen a hospital phrase their concerns so strongly, including repeatedly referring to the teen's situation as "life-threatening." The hospital went through many appeals, yet insurance continued to deny coverage for anything other than outpatient care. This was a teenager who was not medically stable to be in outpatient care, and, without a doubt, met criteria for inpatient. But, in the end insurance won, and the teen and family were discharged and returned for outpatient treatment.
This situation highlights a number of concerns about the role of insurance companies in eating disorder treatment. In this case, an insurance reviewer determined the care that this very sick teenager could receive. Of course, we can all make the argument that in the end it was the parents' decision, but is it really a decision, for the average family, when their option is to pay $30,000+/month, out of pocket, for inpatient treatment? Certainly, the insurance company made the argument over and over that it was "not their fault." "The benefit is exhausted," they proclaimed. Yet, every insurance company has the option of providing additional coverage when the need arises, if they choose. Some will choose to do so; clearly, others will not.
So, what can you do when you find yourself trying to battle an insurance company, or insurance policies in general:
- Lisa Kantor, of Kantor and Kantor, is an attorney in California that is well-loved within the eating disorder community. She is taking on insurance companies and fighting for appropriate coverage for eating disorder patients. So, consider contacting her to see if she can help with your case.
- Appeal, appeal, appeal. You shouldn't HAVE TO fight this hard, but reality is that if you battle the insurance company enough, they often will eventually listen. The squeaky wheel, and all that.
- If the eating disorder has resulted in medical complications, make sure hospitals and treatment centers are billing under medical codes, when possible. So, rather than billing for anorexia, they would bill for the medical sequelae: hypothermia, bradycardia, orthostatic hypotension. Even if the treatment has already been billed under an eating disorder, ask them to correct the bill, providing the medical diagnoses instead. This will mean your medical benefits are used, not mental health.
- Research the mental health parity laws in your state and make sure the insurance company is in compliance with these.
- Contact your legislators and make them aware of the need to address appropriate coverage for eating disorders. Ask them to review legislation in other states, or at the national level, and propose similar legislation in your state.
- Ask the insurance company to flex your benefits. An example might be that you have 10 inpatient days, which generally can be flexed to greater partial (PHP/day treatment) days, and even more additional outpatient days.
- Ask your physician to provide a referral for dietitians and therapists, making it clear the physicians sees these services as paramount to the patient's care.
I'm sure there are other ideas that have worked for others. Please, if you have had success battling an insurance company, share what has worked for you.