If you have Medicare, there are many eating disorder treatment options available to you.
For those in need of residential treatment, an option may be to look at inpatient coverage. Medicare typically covers inpatient treatment, which is traditionally done in a hospital setting and focuses on medical stabilization. Inpatient eating disorder treatment is provided for a short period of time and followed by residential level of care.
If residential is the care you need, then the first thing to do is call Medicare and ask to be assigned a case manager. The case manager is your advocate. They work with you to gain single case agreements and talk with managers and supervisors to get approval.
Once the case manager is assigned, ask the representative what facilities are available for residential treatment. A single case agreement can be made with facilities to gain residential and outpatient care . If a single case agreement is not possible and you are under the age of 26, you can be added to a caregiver or parent’s insurance policy that may cover residential treatment.
Many hospitals and treatment centers accept Medicare for the treatment of eating disorders. If the center is funded in part by country, state, or federal funds, you can request that appropriate care be provided by professionals at the center who are familiar with the treatment of eating disorders.
When you are seeking insurance coverage it is important to know your eating disorder diagnosis, any other psychiatric disorders, physiological complications of the eating disorder, level of care recommended (outpatient, inpatient, partial hospitalization, intensive outpatient), and anticipated duration of recommended treatment .
If you have an outpatient provider, they can help with defining these questions when calling insurance. Often, personnel at the facility will do an assessment and call your insurance for you to obtain benefits.
Medicare Coverage & Benefits
Medicare benefits are offered on open exchanges through the Affordable Care Act.
Typically Medicare, like other health insurance companies, requires that a person obtain outpatient treatment prior to higher level of care . Regardless of the levels of care, Medicare looks at the reasonable and necessary treatment for each person’s condition. Covered services include medication therapy, psychotherapy, and patient education.
If a physician can demonstrate that inpatient treatment is medically necessary for therapy, then typically insurance will cover a duration of inpatient care . Most often, increased risk of relapse without constant care and supervision does not constitute medical necessity. Co-occurring mental health disorders, however, may fall into this category as it increases the risk of complications.
Medicare does cover outpatient treatment services for ongoing therapy after inpatient care. Similar to inpatient coverage, a medical doctor must recommend outpatient care and any psychotherapy or drug maintenance on a case-by-case basis for coverage.
Another factor is preauthorization. Seeking authorization for coverage prior to the start of treatment is important. Medicare can refuse to cover all or part of services requested and a person (or family) is responsible for payment insurance does not cover. This is key information to know before initializing treatment.
If a person needs to begin treatment and the program is not covered by Medicare or the process takes a long time to work out coverage details, there are other options for treatment. These include supplemental insurance, such as health savings accounts; savings from a retirement fund or college fund which could help cover part of treatment; borrowing money from family and friends; and financing treatment with payment plans.
What Medicare Covers for Eating Disorders
Medicare Part B covers partial hospitalization (PHP) in some cases. PHP provides a structured program of outpatient services as an alternative to inpatient care.
Medicare will help cover PHP services when provided through a hospital outpatient department or community mental health center. Medicare will also cover occupational therapy that may be a part of your mental health treatment or individual patient training and education about the eating disorder. .
Medicare only covers PHP if your medical physician and the PHP program accept your request and care needs. Typically Medicare does not cover meals, transportation, support groups, or mental health testing.
When using Medicare, you are responsible for a percentage of payment for each Medicare-approved service you receive. It is important to go over what this looks like with your case manager prior to starting treatment to know what your out-of-pocket costs will be.
There is also a coinsurance payment for each day of PHP services provided, regardless of the setting. Out-of-pocket costs depend on other insurances you may have, medical fees, type of facility, and location of services rendered.
In conclusion, Medicare does cover part or all of the services requested when seeking treatment for your eating disorder. It is important to remember to call and ask for a case manager who can be your advocate prior to, during, and following treatment. It is essential to ask questions regarding coverage for treatment and location of services, out-of-pocket costs, and duration of treatment options.
Treatment Programs Accepting Medicare/Medicaid
- Sheppard Pratt Health System 6501 N. Charles Street Baltimore, MD 21285 410-938-3000 [email protected]
- The Johns Hopkins Hospital 600 North Wolfe Street Baltimore, MD 21287 410-955-3863
- Rosewood (AZ, NM and TX Medicaid) 36075 S Rincon Rd Wickenburg, AZ 85390 928-684-9594
- Rogers Memorial (If outside Wisconsin, patient’s case manager through Medicaid/Medicare must authorize a single case agreement) 34700 Valley Road Oconomowoc, Wisconsin, 53066 800-767-4411 http://www.rogershospital.org/monroe/ Medicare accepted for IP only.
- River Oaks Hospital 1525 River Oaks Road West New Orleans, Louisiana 70123 (504)734-1740 (800)366-1740 • White Horse Ranch 1601 Wilkie Road Mooreland, Oklahoma 73852 Phone 580-994-5649 Fax 580-994-2739 [email protected]
- UNC Center of Excellence for Eating Disorders 101 Manning Dr CB #7160 Chapel Hill, NC 27599 Phone 984-974-3834 Fax 984-974-3779
- Eating Disorder Institute (Takes all Medicare, Takes Medicaid from ND, MT, SD, MN) Route 331 1720 S. University Dr. Fargo, ND 701-461-5300
- UCLA (Only takes CA Medicaid for patients under the age of 25) Los Angeles, CA 310-206-3954
- University of Iowa UI Eating Disorders Services University of Iowa Hospitals and Clinics 200 Hawkins Drive Iowa City, Iowa 52242-1009 Phone: 319-356-2263
- Brookhaven Specialty Hospital 201 S Garnett Rd Tulsa, OK 74128 877-764-8580
- Lindner Center for Hope 4075 Old Western Row Road Mason, OH 45040 513-536-4673
- Walden Behavioral Care (Accepts Medicare for IP Only) 9 Hope Ave, Ste 500 Waltham, MA 781-647-6727
- Denver Children’s Hospital-Eating Disorder Unit 13123 East 16th Avenue Aurora, CO 80045 Admissions Clinician: Vicky Sullivan at 720-777-6452
About the Author: Libby Lyons is a Licensed Clinical Social Worker and Certified Eating Disorder Specialist (CEDS). Libby has been practicing in the field of eating disorders, addictions, depression, anxiety and other comorbid issues in various agencies. Libby has previously worked as a contractor for the United States Air Force Domestic Violence Program, Saint Louis University Student Health and Counseling, Saint Louis Behavioral Medicine Institute Eating Disorders Program, and has been in Private Practice.
Libby currently works as a counselor at Fontbonne University and is a Adjunct Professor at Saint Louis University, and is a contributing author for Addiction Hope and Eating Disorder Hope. Libby lives in the St. Louis area with her husband and two daughters. She enjoys spending time with her family, running, and watching movies.
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.
Published on April 30, 2017.
Reviewed By: Jacquelyn Ekern, MS, LPC on October 13, 2017.
Published on EatingDisorderHope.com