An established treatment program with specialized expertise, adequate experience, and a good reputation can lead to better patient outcomes.

Work proactively with the payer to identify treatment recommendations, however, do not be pressured into accepting the first option offered by the health plan. Investigate the experience and capability of the recommended program. If the proposed treatment provider does not have the required experience or capability, request a letter from them outlining this and their treatment recommendations. This can often be a compelling recommendation.

Investigate what level of coverage is provided for "out-of-network" treatment. Often, there is the right to full coverage for out-of-network coverage if the health plan does not have a participating provider with equivalent expertise in the treatment or service needed.

If the insurance company approves treatment, but not in a specialized program, be prepared to appeal this decision. Or, suggest that the treating clinicians obtain supervision and training from experts in eating disorders. If this treatment does not result in significant improvement,ask the physician to recommend that specialists provide subsequent treatment

• American Psychiatric Association. Treatment Recommendations for Patients with Eating Disorders. Am J Psychiatry. 2006; 163(7 suppl):1-54.
  
  "There is evidence to suggest that patients with eating disorders have better outcomes when treated on inpatient units specializing in the treatment of these disorders that when treated in general inpatient settings where staff lack expertise and experience in treating eating disorders."
  
  
• Society for Adolescent Medicine. Eating Disorders in Adolescents: Position
  Paper of the Society for Adolescent Medicine. J Adolescent Health. 1995; 16:476-480.
  
  "Assessment and ongoing management should be interdisciplinary and are best accomplished by a team consisting of medical, nursing, nutritional, and mental health disciplines. Treatment should be provided by health care professionals who have expertise in managing adolescent patients with eating disorders and are knowledgeable about normal adolescent physical and psychological development[s6] ."
  
  
• Crisp, A.H., Callender, J.S. Halek, E., Hsu, K.G. Long-term mortality in anorexia nervosa: A 20 year follow-up of the St. George's and Aberdeen Cohorts. British Journal of Psychiatry. 1992; 161 104-7
  
  Specialized treatment reduces mortality.