Insurance Coverage for Eating Disorder Treatment

Sharon Zimbler of Montecatini Eating Disorder Treatment Center

Hosted by Sharon Zimbler of Montecatini Eating Disorder Treatment Center
July 30, 2015

EDH: Welcome to today’s #EDHchat! We are excited to have you all with us! We would like to start by welcoming our special guest, Sharon Zimbler.

Sharon is the Executive Director at Montecatini, a Treatment Center for Eating Disorders. Sharon will be sharing with us the process of finding insurance coverage for eating disorder treatment. Thank you for joining us today Sharon!

Please tell us a little about yourself and your work in the eating disorder community.

Sharon: I am a Marriage and Family Therapist and have worked at Montecatini Eating Disorder Treatment Center for over 6 years. I started my career at Montecatini as a program therapist then took on an additional role as the Utilization Review Manager.

I was promoted to the position of National Utilization Review Director for CRC’s eating disorder division in 2014. This was before advancing to the role of Executive Director. I have extensive knowledge of the medical, nutritional and psychological aspects of eating disorders.

I received my Master’s degree in Marriage and Family Therapy from Alliant International University, I then began working on my Doctorate of Psychology degree in Marriage and Family Therapy. I have not completed my doctorate yet, but during my studies, I focused my research on the co-occurrence of Eating Disorders and Substance Abuse.

I have presented nationally and been invited to speak as an expert on eating disorders throughout the country.

EDH: What are some of the challenges that eating disorder sufferers face with finding insurance coverage for treatment?

Sharon: A lot of insurance companies did not cover ED treatment or if they did they would not cover much. Since the parity law has passed, more companies offer insurance coverage but now it is very difficult to get the time needed for treatment.

Insurance companies require that reviews are done regularly to ensure the patient is meeting medical necessity criteria. Insurance companies have ways of skewing the information to make it seem that the person is not meeting criteria.

Patients inevitably end up having to step down to lower levels of care because the insurance company will not pay for continued care.

EDH: What are some tips or suggestions for navigating through these challenges?

Sharon: It is very important to have a copy of your policy, the entire policy. Often times, insurance companies deny coverage based on lack of benefit when a person actually has the benefit. Also, call your insurance company and ask questions. Know your rights as a consumer and call them if you feel you are not receiving the appropriate care.

EDH: If a person does not have insurance coverage for eating disorder treatment, what other resources can they utilize?

Sharon: Unfortunately there are not a lot of resources. Some organizations help people get scholarships. There are a lot of free support groups that can help.

The Affordable Care Act has allowed a lot of people to get insurance who otherwise would not have it. Just check the policy before signing up to make sure it covers ED treatment.

EDH: In what ways do you foresee insurance coverage for eating disorder treatment changing as healthcare evolves?

Sharon: So far, insurance companies have started to raise the price for co-pays and out of pocket costs. This makes it very hard for people to use their benefit if they actually have it. I worry that insurance companies will just continue to make it harder to use the benefit.

At the same time, there are people and organizations fighting for better coverage for eating disorders. There are advocacy groups that are making progress in getting better care for ED patients.

EDH: What encouragement would you have for the person struggling with an eating disorder who has been unable to receive treatment due to lack of resources and/or insurance?

Sharon: Like I said, there are advocacy groups fighting to get patients help. Get in touch with some of them and they can help steer you in the right direction. There are also organizations that help coordinate scholarships for patients.

EDH: Thank you Sharon for sharing this great insight and encouragement about the recovery process. If you or a loved one has been suffering with an eating disorder, we hope this information brings you hope. Recovery from an eating disorder is possible!

For more information about Sharon and Montecatini Treatment Center for Eating Disorders, visit motecatinieatingdisorder.com

Thank you to everyone who participated in our Twitter Chat today! And thank you for the great insight Sharon.

Please stay tuned for future Twitter Chats from EDH!

If you are in need of resources for an eating disorder, visit our website at Eating Disorder Hope.