Thursday, July 16, 2009

Insurance Coverage and Eating Disorders

by Suzanne Rogers, Marketing Intern

Let’s put it out on the table right now so that nobody is shocked a few paragraphs into this blog: On average, eating disorder treatment can range anywhere from $800 per day to $2500 per day. There is no “instant cure” for eating disorders, despite what some may believe; thus, the monthly cost of treatment for one individual can range from about $24,500 to $77,500. Oftentimes, those who suffer from an eating disorder need much more than a few weeks or a month of treatment to fully recover. Some parents take out second mortgages or dip into their 401K’s. According to the Mental Health Parity Act of 1996, insurance companies are required to pay for coverage. This blog will help to explain why this usually does not happen.

The Mental Health Parity Act was originally introduced to Congress more than a decade ago, in 1996. This act requires that insurance companies treat mental disorders equally with physical disorders. For example, if Jane is treated for strep throat at Dr. Bob’s office, insurance will cover the cost. If Jane then goes to Dr. Joe’s facility for eating disorder treatment, insurance should cover the cost, but usually they do not. Most insurance companies limit eating disorder mental health treatment to whether the person is suffering from medical complications from the eating disorder. Others have an annual cap on how many days a patient can benefit from in-patient care, which is usually anywhere between 15 and 30 days. On average, treatment is needed from anywhere between six and twelve weeks to fully recover.

The mental health parity bill was finally passed in November 2008 and will go into effect in January of 2010. What is unknown to many is that this mental health parity bill was pending in the federal legislature for more than a decade because the House and the Senate were unable to agree on the terms of the bill. The bill would make it illegal for insurance companies to place dollar amounts and/or limits on treatment for mental illnesses. Fortunately, we appear to be only six months away from these changes. Unfortunately, the bill has two red flags.

While the bill does call for mental health parity, the law leaves the definition of mental health up to individual states and insurance companies. This means that many states can continue to discriminate against those with some mental illnesses and deny treatment coverage to those who suffer from eating disorders or other deadly psychiatric afflictions. (Interestingly enough, the National Institute for Mental Health confirms that anorexia is a “brain disorder” that can be treated with appropriate mental and physical treatments.) The second red flag is that while insurance companies will now be required to cover mental health, according to their definition, equally with physical health conditions and substance abuse, they will not be required to cover all of them. According to the law, if an insurance company covers mental health and substance abuse it must be done with an amount or level that is considered to be average.

Alaska and Wyoming are the only two states that have not adopted some form of parity, as of July 2008. Out of the 48 states that have adopted a form of parity, only 23 have comprehensive parity laws. The states that are remaining have a plethora of restrictions. Missouri, home of McCallum Place, has mental health parity, but with limits on the coverage. Anorexia nervosa, bulimia nervosa and “other severe eating disorders” are covered, as long as they are listed in the individual plan. Idaho, on other hand, offers mental health parity for state employees only.

Patients who are in treatment at McCallum Place face numerous challenges when it comes to receiving coverage for treatment. Deb Dettmann, MSW, of McCallum Place said that the most frustrating aspect about treatment coverage in general is that insurance companies disagree with how long one should be in treatment for an eating disorder; insurance companies stop seeing the medical necessity long before the treatment team does. This has long-lasting consequences. For a patient who is discharged before going through the entire duration of treatment, relapse is most likely going to occur. In severe cases, this may lead to death. Jennifer Kamer, MA, PLPC, Marketing and Admissions Coordinator at McCallum Place, sees firsthand the sadness and frustration that patients experience when finding out that treatment is ceasing or when treatment isn’t an option at all due to lack of coverage. “No one can get better with 10 or 20 days of treatment. It’d be like giving a cancer patient one-third of chemotherapy treatment; doctors won’t do that. But doctors who are on staff with insurance companies make these decision everyday,” she said.

The good news in regards to the Mental Parity Act is that if your state currently covers eating disorder treatment, it will continue to do so. Dr. McCallum, who doesn’t feel it is helpful to villanize insurance companies, simply wants more education about eating disorders in the eyes and ears of the public so that everybody can have a correct understanding of what an eating disorder is and how it needs to be treated. She also wants better legislation to give those who suffer from an eating disorder the care that is needed.

House Bill 519, sponsored by Rachel Storch and co-sponsored by Rick Stream, is the first eating disorder specific bill introduced in Missouri. HB 519 requires insurance companies to provide coverage for the diagnosis and treatment of eating disorders. On May 5 of this year a public hearing was held and many, including Dr. McCallum, testified on behalf of this bill. While it is too late in the session to pass this bill, supporters are doing all they can to ensure that this bill will be passed in the future. To learn more about HB 519 visit http://house.missouri.gov/billtracking/bills091/bills/HB519.htm .

The National Eating Disorder Association (NEDA) created the STAR Program (States for Treatment Access and Research) to fight for better access to eating disorder treatment by speaking with state legislatures, mobilizing members, and forging alliances with others who share this vision. Visit http://www.nationaleatingdisorders.org/ to learn more or to find out how you can get involved.

2 comments:

  1. This blogs regarding eating disorders always left us intrigued on how we can do to correct this in our children. I gladly read this when I have the chance home. I like to read about Generic Viagra as well.

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  2. Eating disorder is common among teenagers and kids, esp. to young women. Contact eating disorder treatment right away if you have any questions regarding eating disorders.

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