Insurance coverage for eating disorder treatment

When an individual decides to seek treatment for an eating disorder, it often seems like the biggest hurdle has been cleared. However, many may then be discouraged by the insurance process they have to go through. Uncertainty of whether a policy (if they have one) covers needed services can be stressful.

Insurance is complex no matter the case, but strides have been made to increase access to care for those dealing with an eating disorder. The Affordable Care Act, for instance, made changes to how mental health services are covered, which affects treatment for eating disorders and dual diagnosis.

As discussed in a previous post, insurance can be complicated to sort out. However, here are the core points you need to know when arranging treatment for yourself or a loved one.

Mental health benefits are essential under the ACA

The ACA brought major reforms to how health insurance is offered and how policies are structured. One of these was the codification of mental health services as an essential benefit to health plans. It's important to note because treatment for an eating disorder necessarily involves addressing mental health. This is the concept of dual diagnosis, or the condition of suffering from connected mental health and eating disorders.

Before the law, those seeking coverage may have found such policies either limited or more expensive, restricting their options for getting the treatment they needed. And although mental health services are only part of the overall treatment plan, those in recovery don't have to worry about a coverage gap. Other benefits of the ACA to health care for eating disorders include:

• Disallowing providers from declining to cover a patient with a preexisting condition.
• Enabling children to stay on their parents' insurance until 26.

Questions you'll need to ask

The experience of navigating health care can still be difficult, despite the overall trend toward greater access to services for those suffering from a eating disorder. Here are some of the most salient questions you'll need to ask on your own or a loved one's behalf when seeking treatment:

• What doctors can be seen? Every insurance policy will have a group of in-network doctors and health systems approved by the provider. Seeing a physician or a specialist who is out of network can cost more. It's important to figure out beforehand what offices are available under your current insurance.
• What state rules apply? While the ACA changed coverage on a national level, many of the functional decisions on how to implement reform were left up to the states. For instance, many opted into expanding Medicaid, while many other did not. Furthermore, some states may place caps on how often a prescription drug can be refilled, or even if a type of medication can be covered by insurance within the state.
• How will care be coordinated? Treating an eating disorder equals treating physical and mental well-being as a whole, not just the symptoms. Many patients will see a team of doctors or specialists, and need to ask questions about how their care is being handled between stakeholders, as well as if any insurance complications will arise.

Interested in more about health care services if yourself or a loved one is struggling with an eating disorder? Contact Fairwinds Treatment Center today.