Eating Disorders & Insurance
[SIZE="4"]In reading some of the notes in this thread this morning (kudos and much love to all who have posted!), I could not help but notice the discussion of people's struggles in getting insurance benefits for treatment. I hope I may be able to shed a little light on the topic, and perhaps in doing so, others may decide to try to get the help that is out there!
I have been in the medical insurance and billing field for over 25 yrs. For the past 5 yrs, in fact, I have been involved with the Billing Operations for several Eating Disorder treatment facilities across the nation. I have seen huge changes in the availability of benefits , even in that short amount of time. Wonderful strides have been made in the viewpoint of benefits for mental health treatment.
One of the biggest changes is in the Federal Mandates in place for Parity in the treatment of mental health. What that means is , it is now recognized that most insurance plans in this country are now required to view certain mental health diagnosis just the SAME as they would any other medical condition. IE: if the insurance plan offers unlimited office visits for a medical diagnosis such as diabetes or allergies or whatever, they CANNOT then place a limit on office visits for a severe mental illness. No longer can they limit by days, nor on the amount of benefits being paid out.
The major diagnosises covered under the Federal Parity Laws include Anorexia and Bulimia. In some states, they also include ED NOS (Eating Disorders Not Otherwise Specified, sometimes a catch-all for the ED spectrum) The parity laws also usually cover Major Depressive Disorder, and some others.
Not all insurance plans are included in the Federal Mandates, so you should contact your plan's Member Services to see if yours does. Generally speaking, if you have an Individual plan (as opposed to a Group plan) or if your group plan (usually from an employer) is considered a small group plan of under 50 employees), it may not meet the Parity criteria. But even if it does NOT meet the criteria, many forward-thinking plans have begun to offer unlimited benefits for this help.
In any case, I urge anyone who is holding back from looking for help because of fears of whether their insurance might cover the costs, to please contact their plan. Many state insurance plans are also beginning to offer benefits for their members (Medicaid, etc). Yeah, you might have to jump through some hoops, but it is worth it! And also, there are more and more treatment options becoming available, from Inpatient and Residential, to Partial Hospitalization (usually 6-8 hrs a day), to Intensive Outpatient (usually 4-5 hrs per day) to OP. Many facilities are contracted with Medicaid or State-sponsored plans.
I am so blessed to be involved with these programs. I have helped to develop program content for 3 separate facilities, so I know the different types of therapeutic options that are out there.
On a personal note, I have dealt with my own ED behaviors since I was about 4 yrs old. My heart goes out to all who suffer the daily struggles. I know it IS a daily fight, and a daily reprieve. /SIZE]
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