When you or someone close to you is facing an eating disorder, the primary concern is always recovery and well-being. Yet, understanding the financial side of treatment is equally important. The process of figuring out insurance coverage for eating disorder care can quickly become overwhelming. With so many variables at play—such as the insurance plan you have, where you live, and the severity of the condition—it’s crucial to gain clarity on how eating disorder treatments are covered and what you might be responsible for financially.
Does Insurance Cover Eating Disorder Treatment?
The short answer is that most insurance plans do offer coverage for eating disorder treatment, but the details can vary significantly. Factors such as your specific insurance type—whether it’s a PPO, HMO, or another plan—along with your coverage tier (Bronze, Silver, Gold, or Platinum) play a major role. In some cases, mental health benefits may even be handled by a separate company, adding another layer of complexity.
To fully understand what your policy includes, reach out directly to your insurance provider. You can either call the “Member Services” number on your insurance card or log into your account through their online portal. Clarifying your coverage is crucial since benefits often differ greatly depending on your plan.
Understanding the Details of Eating Disorder Coverage
While many insurance policies provide some level of coverage for eating disorder treatment, coverage can be denied or limited in certain circumstances. For example, if the weight is not low enough to treat anorexia, or if you haven’t experienced medical complications from bulimia, your insurer may refuse to cover therapy for those conditions.
Additionally, some plans may include a higher out-of-pocket cost depending on the type of treatment (outpatient vs. inpatient). It’s crucial to confirm which treatments are covered and at what level to avoid unexpected costs.
Does Medicaid Cover Eating Disorder Treatment?
Medicaid coverage for eating disorders depends on your state, as it is a state and federally funded program. Medicaid policies can vary, which means the benefits available in one state may not be the same in another. For example, the California Healthcare Foundation provides specific information for MediCal (California’s Medicaid program), which can help residents understand their state’s unique coverage options for eating disorders.
If you have Medicaid, the best way to understand your benefits is to contact your state’s Medicaid agency directly. They can help clarify the specific coverage for eating disorder treatment and guide you on available services.
Medicaid, being a complex program, might also have limits on the level of care covered. For example, inpatient treatment might only be approved after outpatient treatment has been tried. So, understanding your state’s Medicaid options is essential for determining the treatment levels available to you.
Finding In-Network Eating Disorder Treatment Providers
When seeking treatment, it’s often more affordable to choose providers that are in-network with your insurance plan. In-network providers have agreed to accept specific rates for services, making them more affordable than out-of-network options.
Here are a few steps to help you find in-network eating disorder treatment providers:
Check Your Provider Directory
Start by accessing the provider directory on your insurance’s website. This will help you find therapists, dietitians, and physicians in your area who are covered under your plan.
Look for Centers of Excellence
Some insurers have a network of specialized providers called Centers of Excellence, which feature high-quality treatment options for eating disorders.
Contact Member Services
If you’re unsure, calling your insurer’s Member Services department is a great way to get personalized support in finding the right provider.
Reach Out to Treatment Centers
If you’re interested in a specific treatment program, such as inpatient or residential care, reach out to both the program and your insurance provider to confirm coverage.
Prior Authorization and Eating Disorder Treatment
If you require more intensive treatment, such as residential care or partial hospitalization, you may need prior authorization from your insurance company. This means your provider must first submit a formal request to get approval for these services before they are covered. Prior authorization is often required for high-level care, even if the program is in-network. The admissions department of the treatment center can help you understand what steps need to be taken.
How Much Does Eating Disorder Treatment Cost?
Eating disorder treatment can range widely in cost, depending on the level of care needed. Outpatient therapy visits are generally more affordable than inpatient or residential care. However, the cost can quickly add up, especially for prolonged treatment or multiple visits.
Cost Breakdown of Eating Disorder Treatment
Outpatient Treatment
For individuals who require therapy sessions, dietitian consultations, and medical monitoring, outpatient care is typically less expensive. A single therapy session or dietitian appointment may range from $100 to $300, depending on the provider.
Inpatient Treatment
If you need more intensive care, inpatient treatment can be very costly. A two-week stay in a hospital for eating disorder treatment could exceed $19,000 without insurance. Residential treatment centers, which offer comprehensive therapy and care, can cost over $1,200 per day.
Partial Hospitalization or Intensive Outpatient Programs (IOPs)
These programs provide more structured care without requiring a full hospital stay, typically costing several hundred dollars a day.
What Happens if Treatment Is Not Covered?
If your insurance does not cover a particular treatment program or provider, you may still have options. Some treatment centers offer partial reimbursement for out-of-network services. If your insurance plan has out-of-network benefits, you might be able to pay the full cost upfront and submit invoices for partial reimbursement.
In some cases, a Single Case Agreement (SCA) can be negotiated with your insurance provider, especially if you’re seeking a provider or program that is not available in-network. This agreement allows your insurance to cover the cost for a specified time and rate, providing more flexibility for accessing the care you need.
When Coverage Ends but Treatment Is Still Needed
One common issue many patients face is that insurance coverage may end before the patient has fully recovered. This is particularly problematic when a patient still requires care to prevent relapse or achieve full recovery. In some cases, insurers will require you to step down to a lower level of care before you’re ready.
If this happens, you can appeal to your insurance company to request continued coverage or extend your treatment. Some treatment centers, like Equip, advocate for extended coverage to ensure that patients fully recover and are protected against relapse.
Tips for Communicating with Your Insurance Company:
- During phone calls with your insurer, jot down important details, including the names and direct extensions of anyone who assists you.
- If you don’t get the answers you need, don’t be afraid to follow up or reach out to someone else who might be able to provide more insight.
The Road to Recovery
Dealing with the financial aspects of eating disorder treatment can feel daunting, but it’s important to remember that recovery is possible. With the right support, both medically and financially, individuals can begin to heal from their eating disorders and regain their health. Focusing on finding the right treatment and advocating for the necessary coverage can make all the difference in your recovery journey.