How can we appeal to our insurance for ED treatment coverage?

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Contributor: Courtney Howard, B.A., Executive Assistant at Eating Disorder Hope and Addiction Hope

Obtaining insurance coverage for eating disorder treatment can be challenging, but keep in mind that there are laws and regulations in place that protect your right to mental health care. Do not let insurance barriers keep you from getting the help you need and deserve.

Authorization for Treatment Programs

Many different forms of treatment are available. The level of care recommended for you might depend on your diagnosis and the severity of your disorder. Eating disorder treatment centers typically provide residential, partial hospitalization (PHP), and/or intensive outpatient programs (IOP). Inpatient programs are more often found in hospitals and medical settings. Obtaining coverage for these programs can be complicated, but once you know the process it can go smoothly.

If you are interested in a treatment program at a facility, conduct your own research and find the program that is best for you. You can get referrals from mental health professionals or look for resources online. Then, contact your insurance provider to determine whether they will cover your treatment at the facility. Treatment programs typically call for initial authorization themselves, but it is best if you also call to confirm and keep a written record of all conversations with your insurance company.

Though there are some that truly have your best interests in mind, many insurance companies make obtaining coverage for eating disorder treatment difficult. For example, they begin with providing coverage at the lowest level of care and will only increase coverage if treatment at that level is unsuccessful. It is important to advocate for you or your loved one.

Outpatient Treatment Coverage

Most mental health professionals who specialize in eating disorder treatment do not accept insurance. This is an unfortunate reality that many individuals are faced with upon discharging from a treatment facility and seeking outpatient care.

Woman calling insurance company to check coverage for eating disorder outpatient careHowever, many insurance companies will provide coverage retroactively. You can go to a session with a professional who does not accept insurance, get a receipt, and send that in to your insurance provider. Some companies will then reimburse you for large percentages of the cost. This option still requires you to front the cost and can be risky financially if your provider ultimately rejects your claim for reimbursement.

If it is best for you financially, you might want to try calling providers covered by your insurance to see if they have experience with eating disorders. Many say that they do and include it on their laundry list of specialties, but it is important to make sure they have actually worked with this population. If they have not had experience with eating disorders, they might be unintentionally triggering or not know how to properly hold you accountable in your recovery.

How to Appeal if You Are Denied

If you are denied coverage for eating disorder treatment, you can appeal this decision in two ways.

Health Insurance Claim Form - Shallow DOFFirstly, you can file an internal appeal, which means that your insurance company will review the claim and assess whether the correct determination was made before when your coverage was denied. For this, you will need a breakdown of your benefits, the original claim and denial, and any supplemental paperwork, including notes of conversations with providers and letters from medical or mental health professionals regarding your diagnosis and status.

The second option is an external review, during which a neutral third party evaluates whether the denial was appropriate. You will need similar paperwork as the internal appeal, and this can be done on either a state or federal level. If the external review results in your favor, your insurance provider is bound by law to provide coverage.

The Importance of Treatment

This entire process can seem daunting, especially when you are in the throes of an eating disorder. Try not to let this frustrate you to the point of giving up. While some people are eager for treatment, many might be hesitant and see these insurance struggles as an excuse to avoid seeking help. Instead, feel empowered to stand up to insurance providers and advocate for your mental health.

If you are advocating for a loved one, the same is true. Though it is easier said than done, do not be discouraged by the roadblocks on the way to treatment. Your loved one deserves a happy and healthy life free from his or her disorder.

Community Discussion – Share your thoughts here!

The appeals process with your insurance provider can be challenging when it comes to eating disorder treatment. What have your experiences with this process been?

Courtney Howard Image - 2-17-16About the Author: Courtney Howard is the Executive Assistant for Eating Disorder Hope and Addiction Hope. She graduated summa cum laude with a B.A. from San Diego State University, holds a paralegal certificate in Family Law, and is a Certified Domestic Violence Advocate. After obtaining her certification as a life coach, Courtney launched Lionheart Eating Disorder Recovery Coaching in 2015 and continues to be a passionate advocate for awareness and recovery.

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 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 May 19, 2016
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About Baxter Ekern

Baxter is the Vice President of Ekern Enterprises, Inc. He is responsible for the operations of Eating Disorder Hope and ensuring that the website is functioning smoothly.