Eating Disorders And Your Health Insurance Comapny By Brent McNutt At Isnare.com Ezine Articles

“You’re killing my daughter,” cries a voice through the phone. The truth, though, is that she’s just not sick enough. She has a life threatening eating disorder, but her insurance company doesn’t see it that way. So, her mother is left to plead fruitlessly on the phone for the treatment her daughter needs but can’t afford. Facilities nationwide offer supportive environments and effective therapeutic treatment to people battling these disorders. But for some girls it’s still out too far out of reach.

Most major insurance companies hold an outdated outlook on mental health treatment. According the National Eating Disorder Association, as many as 10 million young girls and women suffer from an eating disorder. However, only a fraction of those with anorexia, bulimia and eating disorders not otherwise specified receive proper treatment. Most women are barred from getting help until they’re close to death’s doorstep.

Typically, insurance companies require an authorization before a member is able to access mental health benefits available on the policy. This means, that while you may have 60 covered days for treatment at a residential eating disorder facility, you are still unable to use them unless insurance says you can. So even if an outpatient therapist and a primary care physician both agree that a more comprehensive approach is necessary, your insurance company may be the deciding factor.

A recommendation for a intensive outpatient program or residential treatment facility has to be “medically necessary” in the opinion of a care manager, the person who makes the decision to pay claims. While this may seem simple and obvious, medically necessary can be an easy out clause for some insurance companies. By making the criteria for authorization of benefits very stringent, insurance companies put off paying for expensive levels of care.

Most of the time, patients are told to seek a lower, less effective level of treatment. They have to wait until this fails before they can try to get into a facility that will actually put them on a road to recovery. Even then, insurance usually cuts your stay much shorter than what is clinically appropriate.

What’s more, many girls are pushed to the point of becoming sicker to get better. Suicide attempts, emergency room visits and surgical procedures to extract a tooth brush that became lodged in a girl’s throat after an attempt to induce vomiting become things that need to happen before there’s any hope to get better.

So, while money is taken out of your paycheck every month in case you get sick, insurance puts obstacles in front of you every step of the way. Just like co-payments and deductibles, the authorization process is designed to deny access to treatment. Even if you’re able to be an exorbitant deductible that is likely to present on your policy, you might have to jump through hoops for months before entering the appropriate level of care. Those in need of mental health treatment, specifically eating disorder treatment, are most vulnerable to this trap.

How can you avoid the mess and access the care that you need? By becoming informed about the details of your benefits and your insurance company’s policies, you’ll know how to get the answers to your questions. Calling and asking your insurance company is not enough. Make sure that you know what you are talking about before you call by contacting the representative at the insurance company who is directly responsible for your employers account. Knowing what terminology to use and what questions to ask will reduce confusion and you’ll have a greater chance of accessing the help you need.

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