It’s no surprise that health insurance companies and medical providers don’t always agree on the best course of treatment—and that even when they do, there’s usually a gap between what an insurer is willing to pay (even for life-saving care) and what a patient can expect to be billed. For patients with an eating disorder, however, the discrepancy can be staggering.
The real cost of eating disorder treatment
According to research from Harvard’s Strategic Training Initiative for the Prevention of Eating Disorders and the Academy for Eating Disorders, the average cost of a hospital stay for a patient with an eating disorder is $19,400—more than double the average $8,900 treatment cost for hospital stays related to schizophrenia and the $8,800 average for alcohol-related hospitalizations. There doesn’t seem to be a good widespread explanation for this discrepancy, other than the fact that eating disorder treatment involves a particularly large team of therapists—and patients’ treatment stays tend to be longer.
Eating disorders cost the US economy nearly $65 billion from October 2018 through September 2019, new research from the same organizations estimates. That figure aims to capture not only the financial costs of treating conditions including anorexia nervosa, bulimia nervosa, and binge eating disorders, but also the broader societal costs. It accounts for lost productivity and the opportunity costs of caregiving—which often falls on family members—as well as treatment costs, which can be hefty on their own.
Health Insurance Terms You Should Know
Insurance refuses coverage
One woman told researchers her TRICARE health insurance plan—offered to military service members, retirees, and their families—wouldn’t cover the intensive $910-a-day outpatient care recommended by her daughter’s treatment team after an eating disorder relapse. She reported spending $10,000 during just one of 13 months her daughter was in treatment.
“Asking staff how people could afford this care, they said often second mortgages were taken, dipping into college savings plans. We had neither of these,” she told researchers.
Another patient told researchers he was unable to find another treatment provider covered under his Blue Cross Blue Shield insurance plan after the sole provider he’d located in his area stopped accepting insurance. When he looked for support groups to fill the gap, he found men weren’t welcome. “His only option was to see a dietitian who saw him on ‘low bono’ rates of $20 per week,” the team wrote.
Being Thin is Just Another Way We Try to ‘Follow the Rules’—But at What Cost?
The study estimated that Americans’ total out-of-pocket payments for eating disorder treatment likely topped $363 million that year—which was, of course, before the pandemic drove sharp increases in the number of people seeking treatment for eating disorders.
Even if you think you’re covered, look again
To further confuse matters, not all health insurance plans cover treatment for all eating disorders. Some plans cover treatment for anorexia but not bulimia, or vice versa, further complicating the financial picture for patients and their families.
Even when treatment for a condition is covered, necessary portions may be excluded or stringent requirements may need to be met. Medicaid, for example, will cover both medical visits and nutritional counseling for diabetics, but won’t cover nutritional counseling—often a key component of treatment—for patients with eating disorders.
What’s the way forward?
There are steps you and your family can take in hopes of making eating disorder treatment more accessible—and organizations that are working to demystify the payment process. In fact, questions about insurance coverage for eating disorder treatments are so prevalent that the National Eating Disorders Association created a toolkit to help people struggling to figure out their insurance plans.
Treatment programs often will provide support for navigating the health insurance maze as well. The Eating Recovery Center in Denver employs teams who specialize in providing the documentation insurance providers require to cover certain courses of treatment.
The Center does not accept Medicare, Medicaid or Tricare, but does offer lower rates for patients paying for their own treatment or whose coverage requires high co-pays or deductibles. It also partners with a health care lender to provide patients with financing.
For assistance that isn’t linked to a specific treatment center, nonprofit organizations like Project Heal help with navigating insurance plans and appealing coverage denials.
Project Heal also maintains a list of treatment centers that accept Medicaid, offers free treatment options through a network of partners, and provides cash to help cover copays and meet deductibles.
The National Eating Disorders Association offers templates for appealing insurance decisions. It also has curated lists of support groups and created a recovery mentorship program.
Source link Health