Contributor: Leigh Bell, BA, writer for Eating Disorder Hope
Many people with BED continuously fight with insurance companies for adequate coverage. This is a common problem for all eating disorders, but because the health consequences of BED are long-term and not as immediate as those of anorexia and bulimia, insurance companies are less likely to acknowledge the need for treatment.
BED is Most Common ED
Binge eating is by far the most common eating disorder, occurring in 1 in 35 adults, or about 3% — almost twice the combined rate for anorexia and bulimia. BED is characterized by recurrent, persistent episodes of binge eating – consuming unusually large amounts of food beyond fullness – without compensatory behaviors, like purging.
BED became an officially recognized mental illness in the latest DSM-5 (Diagnostic and Statistical Manual of Mental Disorders). The manual is used by clinicians to diagnose mental disorders and by insurance companies to determine coverage for mental-health treatment.
This change brought hope that BED would be seen a real, treatable illness rather than a personal decision of poor eating habits – which is a common misconception.
“Medical professional have the potential to become more sensitive to the needs of those who may be suffering from BED, and the importance of providing treatment referrals eating disorder specialists,” according to a statement from the National Eating Disorders Association shortly before the DSM-5 release.
Is it Covered
Will insurance cover treatment for BED? You won’t know until you contact your specific health-insurance provider because every policy is different.
Insurance companies are required to provide mental-health coverage equal just as it does medical coverage, according to the federal Mental Health Parity and Addiction Equity Act. But the law allows employers lots of room to decide what is included in plans offered to its employees. Eating disorders don’t necessarily have to be covered.
The Patient Protection Affordable Care Act, signed into law in 2010 and two years later deemed constitutional by the U.S. Supreme Court, helped by increasing access to insurance and eliminating coverage denial based on preexisting conditions.
Still, insurers don’t have to treat eating disorders like other mental-health conditions, but states can – and several do – require equal coverage. Even these laws are vague, allowing insurance companies to decide what’s medically necessary and, therefore, deny or cut short treatment.
Missouri this year broke ground and became the first state to clearly define what types of eating-disorder treatment insurance companies must cover, as well as ensuring that weight is no longer the only determinate for whether someone’s treatment is insured.
The Missouri law names BED as one of the eating disorders insurance must cover. Insurance companies have until 2017 to implement the changes. This, again, adds hope to insurance coverage for BED treatment because it removes the element of body weight from deciding whether or not treatment is necessary.
Many insurance companies will only cover eating disorder treatment when someone is underweight, which many people with BED or bulimia aren’t. Similarly, insurance will only pay for weight-loss surgery when someone is extremely overweight for a lengthy period of time.
Is Medication an Option?
Depending on policy type, insurance may cover the first and only drug approved to treat BED this year by the Federal Drug Administration (FDA). The drug, Vynase, is alreadly FDA-approved for treatment of Attention Deficit Hyperactivity Disorder (ADHD) in individuals over the age of 6. Previously, only one drug, fluoxetine (Prozac), had been FDA-approved for an eating disorder but only bulimia. The FDA has not approved any medication for anorexia.
Medication is just one piece of the puzzle in the treatment of any eating disorder, including BED. Treatment, at best, is comprehensive and, at least, involves some form of psychotherapy and nutritional counseling. Medical, psychiatric, and other forms of care may also be involved.
Insurance coverage for eating disorder treatment is improving, and we must remember not to give up. Lisa Kantor, an attorney with the California-based law firm Kantor & Kantor, litigates denials of medically necessary treatment for eating disorders and 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.
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 September 18, 2015. Published on EatingDisorderHope.com