Defining Insurance Advocacy in Eating Disorder Treatment

Posted By Kantorlaw || 4-Jun-2014

Treating an eating disorder can be a delicate and multifaceted journey – for everyone involved. Treatment plans often require dedicated “teams” of professionals and experts who are well versed in crafting individualized strategies for recovery. In addition to working closely with providers, the support and encouragement from family and friends can be extremely beneficial…it takes a village to effectively treat an eating disorder. And thus, interference and disruption to this extremely sensitive balance of recovery can be a tragic experience.

Unfortunately, insurance companies are notorious for contributing to these types of disturbances in treatment, including blatantly denying insurance coverage for life-saving treatment, and terminating insurance coverage before the patient has healed enough to discharge safely. The sad truth is - recovery is not exclusively about recovery. It often involves financial distress, infuriating interactions with insurance companies, and the ongoing battle to access the most appropriate level of treatment. With eating disorder treatment comes the inevitable need for insurance advocacy.

So, what does insurance advocacy really mean, and how can you become a successful advocate for insurance coverage?

In its most basic form, insurance advocacy simply means challenging your insurance company after an insurance denial, and fighting for the health benefits to which you are entitled. First, you must understand that an insurance denial is not the final word. Second, stay strong and vigilant. It is important that you don't let your insurance company dictate the treatment plan. Instead, STAY IN TREATMENT and let your provider determine what is appropriate and healthy for you.

Insurance advocacy can mean learning how to effectively communicate with insurance companies. When on the phone with your insurer, be sure to take detailed notes about your conversation. Ask the person for their name, contact information, and qualifications. Put EVERYTHING in writing. The very same day, mail a letter (certified) to the plan/insurer that confirms this conversation.

Families:
• Request a copy of your insurance policy from your insurer….even BEFORE going into treatment. Without your policy, you don’t know the rules! If your policy is unclear, contact our office for help.
• Put everything in writing when dealing with the insurance company, and STAY IN TREATMENT. Under the Employee Retirement Income Security Act (ERISA), we cannot pursue legal action unless we can prove that you lost benefits. The only way you will have unpaid benefits is if you stay in treatment and pay out of pocket, or owe money to a facility.
• As you advocate for insurance coverage, be sure to collect support letters from your treatment team and physicians. This information can be of great value to you if insurance benefits are denied, and you find that you need to pursue legal action.

Providers:
• Ask clients to journal on insurance issues. This can be a very powerful tool in exposing the adverse impact of battling insurance issues while in treatment.
• Be sure to tie your treatment notes to the American Psychological Association (APA) guidelines. Check out the chart on our website for our APA documentation tool, and remember to emphasize the APA criteria that support the level of care you seek!

The patient, family, and treatment team all play powerful roles in insurance advocacy. Work together, use your voice to speak your truth, and ask for what you need!

Working towards recovery and advocating for insurance coverage can be both emotionally and financially exhausting. If you have questions about your policy, or need assistance with an insurance denial, please do not hesitate to contact Kantor & Kantor, LLP for help. We work on a contingency fee basis, which means we do not collect a fee from you unless we get your claim paid.

We understand, and we can help.
Kantor & Kantor, LLP (800) 446-7529

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