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.
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.
• 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.
• 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