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 can be deadly if left untreated, but most 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 the process of securing coverage may be difficult—or even discouraging—it’s important not to give up. Finding covered care 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 to be 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.

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

Insurance

Length of Treatment

Many 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. Often, 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 properly manage.

And 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 which 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 disorder, no matter how promising these newer techniques may be.

Type of Eating Disorders Covered

Many insurance companies will provide coverage for 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:

Your insurance plan may have certain 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 in order 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 you 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 available coverage options to you and provide guidance when submitting claims. They may even be able to 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 certain treatment program or provider, you may still be able to receive coverage by going out of network. Just remember, this option will not be covered by your plan, which means you’ll have to pay for everything out-of-pocket or through other financial programs.

Remember the Appeal Process

It’s possible that 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. For the most specific information about your options, you should consult your insurance company or your policy directly.

Resources

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 little research and effort, it’s possible to navigate the insurance system and access the care you need to recover. 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 difficult, but they’re a necessary part of building a sustainably healthier and happier future.

Resources

Eating Disorders. National Institute of Mental Health. Accessed March 2023.

The opinions and views of our guest contributors are shared to provide a broad perspective on 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.

Published on April 12, 2023, on EatingDisorderHope.com