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Navigating insurance coverage for the treatment of eating disorders

At long last, you or a family member decide to reach out for help, to make a life change and seek treatment for an eating disorder. However, even this seemingly simple first step can be a daunting task for many, requiring great bravery in the midst of a disease that thrives on keeping people weak.

You may soon discover one of the most disturbing barriers to eating disorder recovery: An insurance denial. Almost as fervently as you committed yourself to seeking treatment for yourself or a family member, your insurance company--almost certainly not a qualified doctor, therapist or eating disorder expert--decides that treatment is not possible. They decide that treatment is not medically necessary or that the appropriate level of treatment is not covered under your health care plan. Basically, they are telling you that the treatment essential to your health, or your family member’s health, is not necessary.

Consequently, it is vital to familiarize yourself with the advice in this article to prepare yourself to advocate for insurance coverage.


Do

Do understand treatment options for eating disorders

There are many different treatment options for eating disorders. To be effective, treatment must address both the physical and psychological aspects of the issue. A treatment plan can include psychological counseling, as well as nutrition education and medications, such as antidepressants. The right approach for each individual depends on the specific symptoms, issues and severity of the disorder.

The goal is to treat any medical or nutritional needs, promote a healthy relationship with food, and teach constructive ways to cope with life and its challenges. If an eating disorder does not improve with standard treatment or causes health problems, hospitalization or an inpatient program is sometimes necessary. An organized approach to eating disorder treatment can help individuals manage their various symptoms, find a healthy sustainable weight, and maintain physical and mental health.

Do contact an attorney after a written insurance denial

Once your claim has been denied by your insurance company--and you have an actual denial in writing--contact an attorney for help. You can call some law firms for a no-cost consultation. Remember that some attorneys work on a contingency fee basis, meaning you do not pay a fee unless they get your claim paid.

Do stay in treatment

In order for an attorney to help you or a family member, you must receive treatment and remain in treatment, even after a denial of benefits.To seek reimbursement, the law requires proof of an outstanding bill or payment for the treatment.

Treatment is extremely costly, and when your insurance company denies coverage, this can become an even more stressful time for families. After all, who wants to focus on financial burden instead of recovery and treatment? However, for effective recovery, be sure to follow your treatment providers' recommendations (not your insurance company’s) for treatment protocol, level of care and length of treatment. Allow your lawyer to work with your insurance company and seek reimbursement of the benefits available under your policy.

Do request a copy of your insurance policy

Without a copy of your policy, you will not be familiar with the rules. Request a copy from your employer or the insurance company--and read it thoroughly. Insurance companies are required to give you a complete copy upon your request. Every plan and state has its own rules and timing limitations with regard to submitting appeals and filing a lawsuit. It is common to encounter statute of limitations from as little as 30 days to as long as four years. But do not let this prevent you from pursuing an appeal or litigation.


Don't

Do not think that an insurance denial is the final word

With a little advocacy, research and determination, you can gather the tools needed to fight for the health benefits to which you are entitled. For some, it might be possible to overturn a denial without legal assistance. If a case becomes too complex to manage on your own, you may want to consider seeking assistance from a reputable professional.

Do not allow the cost of treatment to deter you from seeking help

If you do not currently have insurance, there are many scholarships available for eating disorder treatment. Some of these can be found by visiting:

Do not feel shameful about seeking treatment

It is not uncommon for individuals who suffer from eating disorders to feel shame. Try not to let your eating disorder “self” talk you or a family member out of seeking help. Eating disorders are a guilt- and shame-ridden disease, but treatment can help you work through these feelings.

Do not stop following the recommendations of your treatment team

Under ERISA (Employee Retirement Income Security Act), you have the right to file a lawsuit to recover unpaid benefits. If you do not have unpaid benefits, there is no ERISA claim. If you have been denied benefits by your insurance company for treatment, but leave treatment without paying anything out of pocket, you do not have unpaid benefits. Clients should seek proper treatment based on their treatment provider’s recommendations, not the treatment dictated by the insurance company.


Summary
Jumping cartoon

Many people are unsure about what to do when an insurance denial occurs. When your insurance company denies access to health benefits, it only intensifies an already distressing situation. It is imperative that individuals struggling with eating disorders have access to the life-saving treatment to which they are entitled.

Keep these tips in mind when beginning your recovery journey. If your health claim is denied, following these guidelines will make it much easier to get your benefits recovered--and that means having access to treatment and the chance for recovery.


More expert advice about Eating Disorders

Photo Credits: © Ana Blazic Pavlovic - Fotolia.com; Check Man, Cross Man and Jump Man © ioannis kounadeas - Fotolia.com

Lisa S. KantorPartner, Kantor & Kantor

Lisa Kantor, a Los Angeles lawyer and partner in Kantor & Kantor LLP, represents people denied health benefits for treatment of both physical and mental illnesses. Most recently, Ms. Kantor has focused her efforts litigating insurance company de...

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