Exploring Insurance Coverage for Eating Disorder Treatment

Navigating the world of health insurance can be challenging enough on its own, but the practice can be especially difficult when seeking coverage for the treatment of eating disorders.

These conditions are dangerous, and some can be deadly if left untreated. Still, many insurance companies require proof of diagnosis or other rounds of approval before your covered care can begin, which can, unfortunately, delay the treatment process.

Still, even though securing coverage may be difficult—or even discouraging—it’s important not to give up. Finding covered care for eating disorders is possible, and it’s a crucial aspect of recovery from these demanding mental health disorders.

Health Insurance and Eating Disorders

Eating disorders may seem extreme, but they’re more common than many people may think. Most insurance companies consider this type of care part of their mental health benefits. Still, they often utilize complex processes to tabulate the care and coverage options available for people struggling with these conditions.

An insurance company may base their eating disorder coverage on factors such as:

• The specific condition someone is struggling with
• Whether the person has previously tried eating disorder treatment
• The level of care required for the person’s condition

To determine many of these factors, the insurance company will likely want to see an official diagnosis from a medical provider—possibly one within their network—as well as other paperwork verifying the person’s medical history and other details.

Many insurance policies will also offer partial coverage options, particularly for longer-term or more expensive aspects of eating disorder care. For example, your policy may cover 100% of care for the first 30 days in an inpatient program, then only cover 50% of the following 30 days, and so on. As always, it’s best to check with your provider about your specific plan, as each could offer unique coverage.

There are other factors you should consider when preparing to talk to your insurance provider about eating disorder coverage.

Length of Treatment

Some types of care for these conditions can be lengthy, and insurance benefits may not extend throughout the entire program.

Prolonged treatment involving inpatient or outpatient care is a huge consideration for insurance companies. At times, there may be disagreements between treatment centers and insurance companies on how long someone should remain in a program. 

Typically, treatment centers want to keep patients until they’re considered medically stable and have learned the types of coping skills that can help them achieve long-term recovery. Many insurance companies, meanwhile, have more generalized timetables for coverage.

Type of Treatment

Eating disorders, such as bulimia nervosa, anorexia nervosa (AN), and binge eating disorder (BED), are extremely complex, often requiring emotional, medical, and nutritional care to manage appropriately.

While some forms of care for these conditions have been around for a long time, many new therapies have been, or are being, developed.

Still, insurance companies, more often than not, will only cover “evidence-based” treatments or those that have undergone numerous clinical trials or otherwise been proven effective. This can leave out many of the newer, more cutting-edge technologies and treatments being tried to help people overcome their eating disorders, no matter how promising these newer techniques may be.

Types of Eating Disorders Covered

Many insurance companies will provide coverage for the treatment of certain types of eating disorders. For example, since bulimia nervosa (BN) is one of the most widely studied and understood of these conditions, most policies should cover care for this diagnosis.

Bulimia nervosa is a serious mental disorder characterized by episodes of binge eating followed by compensatory behavior, such as self-induced vomiting, laxative abuse, or excessive exercise.

Individuals struggling with this condition often develop both physical and psychological consequences that must be tended to in order to help the person achieve recovery. To help address these issues, an insurance policy may cover different types of care, such as:

• Psychotherapy sessions
• Nutritional counseling and education
• Physical therapy sessions

Your insurance plan may have specific exclusions or limits on coverage for treatment. For example, some plans may only cover a certain number of therapy sessions per year or may only cover treatment at in-network providers. 

It’s important to read the details of your insurance policy to understand the nuances of what it will and will not cover for eating disorder treatment. You can also call your provider if you have any questions.

Navigating Insurance Options

Navigating insurance coverage for eating disorder treatment can be daunting. But there are a few tips that can help the process go more smoothly.

Talk to the Insurance Provider

The first step in gaining coverage for the treatment you’re seeking is understanding the available coverage options.

You can read through your policy to get a better idea of the details or speak with the insurance provider directly. They can offer information on what is covered under each plan and the costs you may be responsible for.

Get Help from the Treatment Program

Most treatment programs have staff members who are experienced or even specialized in working with insurance companies.

These staff members can help explain coverage options to you and guide you when submitting claims. They may even point you in the direction of further financial help should your insurance company fail to cover all costs.

Look Into Out-of-Network Options

Even if your insurance plan does not cover a particular treatment program or provider, you may still be able to receive coverage by going out of network. Remember, your plan will not cover this option, so you must pay for everything out-of-pocket or through other financial programs.

Remember the Appeal Process

Even after researching treatment options and finding a center or therapy you prefer, your claim for coverage may be denied. In these cases, it may benefit you to appeal the decision directly with your insurance company.

An appeals process can be complicated and stressful. The treatment program you want to enroll in may have staff members who can help you with this process and utilize other information to help change the insurance company’s mind.

Every insurance company is different, and their claims process will also vary. You should consult your insurance company or policy directly for the most specific information about your options.

Finding Help for Your Eating Disorder

Eating disorders can have serious consequences if left untreated. Don’t let financial barriers keep you from getting the help you need. 

With a bit of research and effort, navigating the insurance system and accessing the care you need to recover is possible. If you aren’t sure where to start looking, you can speak with your regular physician, ask your therapist or psychiatrist, or call an eating disorder hotline for additional help or resources.

These steps may be complicated, but they’re necessary to build a sustainably healthier and happier future.