Securing insurance benefits for the treatment of an eating disorder can be an extensive battle. This battle often comes in the form of repeated denials, being told you can "be safely treated at a lower level of care," appeals, and even being quoted incorrect benefit information. Those who suffer from eating disorders, and their families, are often left in the position of trying convince their insurance company that their illness does in fact meet medically necessary criteria. As insurers aim to "keep health coverage affordable," the result is that those suffering from eating disorders are often left without access to life saving treatment.
In addition to facing the enormous pressures to recover as soon as possible, many individuals experience even more pressure, and a great deal of stress, because of the financial burden of treatment. Although The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) "requires that if a group health plan offers coverage for mental health or substance use disorder benefits, the financial requirements and treatment limitations for those benefits can be no more restrictive than the predominant requirements and limitations applied to substantially all medical/surgical benefits," insurance companies continue to find ways around the law, and continue to blatantly deny treatment.
When asked about denials for treatment of eating disorders, two insurance companies in Alabama recently declined to be interviewed. Instead they offered the following written statements to the Birmingham News:
From Blue Cross Blue Shield of Alabama:
"The coverage provided by any health plan varies according to a plan's
specific benefit design. The acute treatment of eating disorders is usually
covered under a health policy's mental health benefits if the treatment
meets inpatient or outpatient medical necessity criteria. Long-term chronic
treatment of eating disorders in a residential treatment facility is usually
not a covered benefit. "
From VIVA: "VIVA covers medical issues related to eating disorders and mental health care for underlying conditions causing eating disorders. Like many health plans, in an effort to keep health coverage affordable, our plans do not cover residential treatment for any condition, including eating disorders. Residential treatment occurs outside of a hospital, in a live-in setting where the patient stays for a prolonged period, sometimes months."
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Dealing with, and seeking treatment for eating disorders can be emotionally and financially devastating, but it doesn't need to be that way. Kantor & Kantor, LLP has developed a specialized legal practice representing clients whose claims for treatment of eating disorders have been wrongfully denied by their insurance company. If you have been denied treatment for an eating disorder by your insurance company, we can help. Call (888) 569-6013or log on to Kantor & Kantor, LLP to learn more about how we can help you. We offer no cost consultations, and we work on a contingency fee basis which means you don't pay us a fee unless we get your claim paid.