Many insurance companies have policies or practices that create challenges and confusion for patients who are seeking insurance coverage for the treatment of an eating disorder. Despite your FEELINGS OF FRUSTRATION AND HELPLESSNESS with a denial , there are steps you can take to educate your insurance providers and increase the likelihood of a favorable outcome. This information is designed to help you secure treatment for your family member who is suffering from an eating disorder. Don’t give up! Use denials as an opportunity to educate insurance companies about the necessity of treatment and the devastating consequences of denying coverage.
Proactive efforts on the part of clinicians are essential to assist patients in appealing denials or terminations of treatment. Use denials as an opportunity to educate insurance providers about the necessity of appropriate treatment and the devastating consequences when treatment is unavailable. With guidance and support, many families are successful in obtaining needed services via appeal, waiver, or negotiation, even in the case of plans with limited coverage. Often, your help and persistence are instrumental to a favorable outcome.
A person seeking treatment of an eating disorder may encounter significant barriers in receiving insurance coverage of the prescribed care. Efforts to appeal the denial may be effectively enhanced by the intervention and advocacy of an attorney including letters accompanying appeals and coordinated efforts with a person’s treating physician.
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About tHIS TOOL KIT
This web site provides resources for patients and families, clinicians and health professionals, and for attorneys and others who advocate on behalf of individuals with eating disorders. The materials are intended to assist those struggling with an eating disorder to ensure that they receive appropriate insurance coverage for the treatment they require.
Each resource page provides a variety of information:
- General strategies for communicating with insurance providers
- Accurate medical information to guide your discussions with insurance providers
- Guidance in determining appropriate levels of care
- Strategies for appealing denials of care from insurance providers (including sample letters)
- Additional links and resources.