Contributor: Leigh Bell, BA, writer for Eating Disorder Hope
Two decades ago, Rick Stream walked into his daughter’s room singing a good-morning song but Katie didn’t move. Her heart had stopped beating as the result of bulimia.
Two decades after burying his teenage child, the former Missouri Senator finally saw a legislative bill he launched become state law to require insurance companies to treat eating disorders based on recommendations from the American Psychiatric Association.
Missouri Makes History
Missouri is the first to pass such rigid requirements that insurance companies cover eating disorder treatment. Elsewhere in the United States coverage for eating disorder treatment is inconsistent.
Despite a federal mandate that insurance companies cover mental and physical illnesses equally, some policies don’t pay for the eating disorder treatment needed for recovery.
Every eating disorder specialist believes limitations of managed care cause some of their patients to relapse, the EDC reports.
One major setback is weight. Many insurance providers stop paying for treatment when a client reaches 80% of his/her body weight or if his/her blood work stabilizes. Yet, neither measure is a dependable indicator of the physical or emotional well-being in someone with an eating disorder.
Lisa Kantor, an attorney with Kantor & Kantor who litigates denials of medically necessary treatment for eating disorders, offers this advice for getting insurance to cover eating-disorder treatment:
- Familiarize yourself with your insurance policy or health benefit plan. Obtain a copy from your employer or insurance company if you don’t have one.
- Understand the insurance policy’s coverage for treatment at an in-network facility versus an out-of-network facility.
- Ask your insurance company for a list of in-network treatment facilities.
- If the insurance company has no in-network facilities in your area or state, ask your insurance company for a single case agreement with your preferred treatment facility in your area.
- Document that the treatment is medically necessary by providing your doctor’s written support, your own letter describing your need for treatment, and if available, letters of support from family members or co-workers.
- Document what forms of therapy and treatment you have exhausted by submitting copies of all treatment records to the insurance company.
- Ensure that your facility communicates with the insurance company in writing and retains records of correspondence.
- Keep records of all out-of-pocket expenses for future reimbursement.
- Find out if your state has a Mental Health Parity Law. The National Alliance on Mental Illness has a chart outlining the mental health parity laws for each state.
- Obtain a copy of the treatment facility’s license to determine if it qualifies as a hospital, skilled nursing facility, congregate living facility, or other health facility license through the state.
Community Discussion – Share your thoughts here!
What successes have you had with insurance coverage for disordered eating? What advice do you have to share?
About the Author:
Leigh Bell holds a Bachelor of Arts in English with minors in Creative Writing and French from Loyola Marymount University in Los Angeles. She is a published author, journalist with 15 years of experience, and a recipient of the Rosalynn Carter Fellowship for Mental Health Journalism.
Leigh is recovered from a near-fatal, decade-long battle with anorexia and the mother of three young, rambunctious children.
The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.
We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.
Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on November 3, 2015. Published on EatingDisorderHope.com