Recovery

Some words on insurance coverage (or lack thereof)

Eating disorder treatment is expensive, costing upwards of thousands of dollars per day. Families of patients need as much financial help as they can get to provide their loved ones the care that they need, but one of the biggest obstacles in eating disorder treatment is the very thing that is supposed to make it easier: insurance coverage.

Since there are no federal regulations requiring coverage for treatment, insurance companies hold the decision-making power. According to an article on NOW.org, insurance companies argue that “there are no ‘standards’ prescribed for the treatment of eating disorders and that this lack of medical protocol gives them the authority to determine whether or not a recommended treatment is medically prudent.” This results in little to no coverage for patients.

While I was in treatment, my insurance was constantly being reevaluated. I was kept inpatient for two weeks before being moved to outpatient, where I lived in a halfway house on the hospital’s campus with other eating disorder patients. I think they moved me there because insurance would only have to cover the days where I was actually on the unit receiving treatment, and not my “days off.” During this time, I was sent to the unit a couple of days out of the week (compared to the 24/7 nature of being inpatient). I was discharged after two months, as soon as I hit my prescribed “goal weight range,” although I didn’t necessarily feel comfortable or ready to deal with the new weight and the challenge of maintaining recovery.

The struggle of insurance hasn’t stopped there. This past year, my insurance company dropped me due to the health complications I’ve incurred from my eating disorder. Now I’m on a different insurance plan than the rest of my family, and my copays for my four prescription medications have raised from $35 to upwards of $75 or $100 each. I know that I have technically done this to myself, but I believe eating disorders are a mental illness, not a behavioral illness, and should be treated as such by insurance companies. The only way this can be achieved is through research and awareness, something that is unfortunately lacking.

Consider these statistics from NEDA:

  • Funding for eating disorders research is approximately 75% less than that for Alzheimer’s disease, despite there being 10 million eating disorder sufferers compared to Alzheimer’s 4 million.
  • Research dollars spent on anorexia averaged $0.70 per affected individual, compared to over $159.00 per affected individual for schizophrenia.
  • The average direct medical costs for treating eating disorder patients in the United States is currently between $5-6 billion per year, whereas the global cost of anti-psychotic medication is $7 billion per year.
  • Anorexia nervosa has the highest premature mortality rate of any psychiatric disorder. The majority of deaths are due to physiological complications.
I have a lot of friends who have gone through a number of stints in treatment facilities that were cut too short, some having been admitted two, four, even eight times. Wouldn’t it be more cost-effective for insurance companies to cover the full stay the first time around, to create a stronger foundation for recovery and avoid these multiple admissions? Prematurely ending treatment is dangerous because it really disables a patient’s chances for a full recovery. It’s common for patients to relapse and even die from complications because they hadn’t gotten enough help when they needed it most. Instead of being discharged when the insurance companies have reached the limits of their coverage, patients need to go when the doctors decide that they are ready and properly equipped for recovery.
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One thought on “Some words on insurance coverage (or lack thereof)

  1. Pingback: Last day of Awareness Week | 42nd Chance

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