The Significance of Health Insurance in ED Treatment

Recovering from an eating disorder can be challenging, but not impossible with help of a treatment team. It is important to mitigate stress during this time, and the cost of eating disorder treatment can often be a stressor for many. It is important to keep your focus on your recovery during this time, which can be difficult, especially when facing the stressor of whether or not treatment is affordable.

For many patients undergoing eating disorder recovery, treatment is based on a multidisciplinary approach, with numerous specialists working as a team to provide the best treatment possible Often eating disorder treatment includes therapy, psychiatry, PCP visits and sometimes other specialists are warranted due to physical complications, in addition to nutrition assistance and counseling. While having this team approach is vital to the recovery process, it can be confusing in regards to finding coverage for these specialized services, since the treatment process involves both physical and mental health specialists.

Unfortunately, there are some challenges with receiving coverage from insurance companies to treat eating disorders. There are some instances when insurance companies will deny coverage for eating disorder treatment if specific criteria are not met. Some of these qualifications can be particularly detrimental, or triggering, to someone going through the process of recovery. Insurance companies can deny coverage if the patient’s weight is not “low enough”, or if their eating disorder has not caused any other medical complication, which would alter their lab values This is particularly dangerous to many patients, as it can make their illness feel insubstantial, or undeserving of care. Not only do patients have to worry about paying for their treatment, but they are also hearing from the insurance company that their treatment will not be covered due to them not being “sick enough” in the eyes of the insurance companies. This might lead patients to wait to get help so that their insurance can cover it, but eating disorders almost always get worse the longer they are left untreated. Other patients might be reluctant to admit that they need treatment, and the potential challenges with insurance coverage add another obstacle to them receiving treatment.

Despite these challenges, it is still important for patients to communicate with their insurance company and document any expenses they have. Having their expenses documented will help with reimbursement for any expenses that they might have had to pay themselves, if not filed by the insurance company itself. Patients who are seeing an out of network provider might have to request a superbill from their provider to submit to their insurance company for reimbursement. The superbill is a way that the patient can request reimbursement from their insurance company, even if they are seeing a provider that is not in-network.

Eating disorder recovery may be difficult, but having a qualified team as support is an important aspect of the road to recovery. Having to worry about the financial aspect of treating eating disorders is an additional stressor that should be mitigated by one’s health insurance. Insurance can be difficult to navigate, especially with the multidisciplinary approach that often comes with the treatment of eating disorders, so it is important to have a line of communication with insurance companies to make this process focused on your recovery, instead of the overwhelming costs of the treatment itself. 

There are also resources available for those patients that do not have insurance. Community health groups and other support groups are potential options to discuss the recovery process with others, and are options for individuals to find support. In addition, some non-profit organizations have scholarships to help pay for some individuals’ eating disorder recovery treatment. While eating disorder treatment can be expensive without health insurance, there are other options and ways to find the support these individuals need. Below are a few links to these organizations that might be able to help with the financial aspect of recovery.

  • Health Resources and Services Administration (HRSA), is one federally funded program that provides primary care services to individuals in need. 

https://www.hrsa.gov/opa/eligibility-and-registration/health-centers/fqhc

  • Project Heal: A non-profit organization that provides scholarships and other services to help individuals with eating disorders. https://www.theprojectheal.org/ 

Sources:

Evans. (n.d.). What Is a Superbill for Therapy? GoodRx. Retrieved October 25, 2022, from https://www.goodrx.com/insurance/health-insurance/superbill-therapy

Gordon, D. (n.d.). Despite Progress, Patients Still Struggle With Insurance Coverage For Eating Disorder Treatment. Forbes. Retrieved October 22, 2022, from https://www.forbes.com/sites/debgordon/2021/02/26/despite-progress-patients-still-struggle-with-insurance-coverage-for-eating-disorder-treatment/


Insurance & Legal Issues. (2017, February 21). National Eating Disorders Association. https://www.nationaleatingdisorders.org/learn/general-information/insurance

Kritz, F. (n.d.). How Much Does It Cost to Treat Bulimia, Anorexia, and Eating Disorders? GoodRx. Retrieved October 23, 2022, from https://www.goodrx.com/conditions/eating-disorders/eating-disorders-treatment-costs


Navigating Insurance Coverage for Eating Disorder Treatment. (2015, October 12). Center For Discovery. https://centerfordiscovery.com/blog/navigating-insurance-coverage-for-eating-disorder-treatment/


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