Friday, March 22, 2024

Does Medicare Cover Eating Disorder Treatment

Don't Miss

Types Of Eating Disorders & Treatments

Eating disorder treatment funding boost will absolutely save lives | ABC News

Eating disorders are a group of conditions characterized by excessive food and weight difficulties. Still, each disorder has its own set of symptoms and diagnostic criteria.2 Below are the symptoms of six of the most common eating disorders:

  • Anorexia Nervosa: Anorexia is defined by an abnormally low weight and a strong desire to avoid gaining weight or overeating.
  • Behavior associated with this eating disorder aims to prevent weight gain at all costs, frequently to the point of malnutrition. Even though the body weight is well below normal, a person suffering from anorexia may perceive themselves as overweight.
  • Bulimia Nervosa: Binge eating followed by purging characterizes bulimia. When you have bulimia, you may feel guilty or powerless after consuming a significant amount of food. As a result, you attempt to vomit it up.
  • To expedite the passage of food through the digestive system, one may utilize laxatives. One may also over-exercise to avoid gaining weight due to eating. One may believe theyre overweight even if their weight is average, slightly over normal, or below a healthy weight.
  • Binge Eating Disorder: Binge eating disorder, or BED, is a condition in which you regularly overeat. One might also feel terrible about bingeing or as if its out of their control. Persons suffering from BED may eat long after full, even to the point of discomfort or nausea.
  • Symptoms of an eating disorder vary by disorder however, the following are the most common:

    Getting The Best Care Possible

    As you prepare to enter treatment, learn as much as you can ahead of time so that you will know exactly what your coverage includes and exactly what you will be expected to pay out-of-pocket.

    Please know that we do not work directly with Medicare, Medicaid or Tricare.

    If your insurance does not cover care at ERC Pathlight, we will work with you and your family to establish self-pay rates. We will do our best to find a financial solution that allows you to get the care you need and deserve. This option is helpful if you are experiencing one of the following situations:

    • Dont have health insurance
    • Lack eating disorder treatment benefits
    • Have high co-pays or deductibles
    • Are denied coverage by your insurance provider
    • Have a limited number of treatment days

    In some cases, you will be able to appeal to your insurance company for reimbursement of some of the fees.

    What If I Already Have A Mental Health Care Plan

    If you still have sessions left on a Mental Health Care Plan under Medicare, you will be required to use the remaining sessions before commencing an Eating Disorder Plan . You may still want to visit your GP in the lead up to the completion of your Mental Health Care Plan to prepare for potentially moving onto an EDP.

    The sessions used on the Mental Health Care plan will come off your total entitlement to EDPT sessions on the Eating Disorder Plan . Ie. If you have used 10x MHCP sessions, you would only get a maximum of 30 EDPT sessions in that 12-month period.

    Don’t Miss: What Benefits Do You Get With Medicare

    Consultation Items And Treatment And Management Plan Items

    Some eating disorder treatment and management plan items cant be claimed with some other consultation items on the same day for the same patient.

    The MBS item and explanatory notes provide more information about what consultation items you cant claim with an eating disorder treatment and management plan item.

    The Mental Health Parity And Addiction Equity Act

    Pediatric Therapy Provider DotCom Therapy Enters the Medicaid Market ...

    The Mental Health Parity and Addiction Equality Act, signed in 2008, is a law that requires insurance companies to provide coverage for mental health and substance use disorders equivalent to that for physical health problems.

    This applies to most larger group health plans. For example, the law requires that insurers do not set behavioral health visit copays higher than medical visit copays at the same level of care. The parity law also impacts treatment limits, mostly eliminating the annual session caps that used to be common among mental health programs.

    Don’t Miss: Do I Need To Pay For Medicare

    Accessing Medicare For Eating Disorders

    If you are concerned that you or someone you care about is experiencing an eating disorder, such as anorexia nervosa, bulimia nervosa or binge eating disorder, its important to make an appointment with a medical practitioner. For most people this will be a GP, but it also includes paediatricians and psychiatrists.

    How to prepare for your appointment

    • Its important to see your regular GP who knows you, or a GP that you are comfortable with. If you dont have a regular GP, look for a GP that has mental health as one of their treating specialties.
    • To ensure there is adequate time to cover the assessment and referral process, it is advisable that you ask for a double appointment when you book and mention that you are wanting an Eating Disorder Plan .

    When youve made an appointment, its a good idea to start getting prepared for your appointment so you dont feel put on the spot. It might be helpful to write down any symptoms or behaviours youve been experiencing, as well as any questions you might want to ask the doctor.

    For anyone over the age of 18:
    For parents/carers of children under the age of 18:

    Need help talking to your doctor?

    Going to the doctor for concerns around an eating disorder can feel like a big step. Understanding what is likely to happen at your appointment can help ease your anxiety.

    c. other specified feeding or eating disorder.

    The eligibility criteria, for a patient, is:

    Verify Insurance Coverage And Find The Best Treatment Programs

    The Blue Cross and Blue Shield Association is one of the most well-known names in the world of health care. Eating disorders are serious issues that affect millions of people each year, so its no surprise that the largest insurance companies offer comprehensive care and support to their customers who suffer from eating disorders.

    If you or a loved one are experiencing the symptoms commonly associated with an eating disorder, consider contacting your local Blue Cross Blue Shield office to find out which forms of treatment are covered under your plan. For more help finding the best treatment programs in your area, call our toll-free helpline at . We are available 24/7 to take your call and give you information on verifying coverage for your Blue Cross and Blue Shield Association insurance policy.

    Additional Resources

    As advocates of mental health and wellness, we take great pride in educating our readers on the various online therapy providers available. PsychGuides has partnered with several thought leaders in the mental health and wellness space, so we can help you make informed decisions on your wellness journey. PsychGuides may receive marketing compensation from these companies should you choose to use their services.

    Read Also: Who Offers Medicare Supplemental Insurance

    Contributor: Jessica Setnick Ms Rd Cedrd Founder Of The International Federation Of Eating Disorder Dietitians

    This week for the first time, a dollar amount was assigned to the economic burden of inadequate treatment of eating disorders in the US. That cost is in the billions.

    A significant portion of the cost is accounted for by emergency department visits and repeat hospital stays, costs that could largely be prevented with simple outpatient care. So why do individuals with eating disorders, successfully treated in the hospital, relapse to the point of needing the ER? Heres my theory.

    Patients in the hospital for any reason are screened by Registered Dietitian Nutritionists and, when indicated, receive Medical Nutrition Therapy . This benefits the patient and also saves the system money since nutrition is the foundation for almost everything else.

    Reversing malnutrition and dysfunctional eating makes medications work better, shortens surgery recovery time and hospital stays, improves immunity and pregnancy outcomes, reduces readmission rates, decreases NICU time, and on and on and on.

    In the short term, the value of MNT is clear and obvious. But chronic, ongoing conditions diabetes, kidney failure, eating disorders need ongoing care, long past a stay in the hospital.

    MNT improvements need to be maintained, whether at a medical office, clinic, or virtually from home. Its available for people with diabetes or kidney failure even after they leave the hospital.

    Medicare Coverage For Depression

    10 Severe Eating Disorder Case Studies at ACUTE Center for Eating Disorders and Severe Malnutrition

    An estimated 17.3 million American adults had at least one major depressive episode in 2017. This number represented 7.1% of all U.S. adults. Many others suffered from bipolar disorder, dysthymia, seasonal affective disorder, premenstrual dysphoric disorder, and depressive symptoms related to medical conditions or substance use.

    Treatment for these conditions may include medications, psychotherapy, and hospitalization as mentioned above. For severe depression that fails to respond to other treatments, electroconvulsive therapy or transcranial magnetic stimulation may also be an option.

    Electroconvulsive therapy is a procedure that uses electrical currents to trigger seizure activity in the brain. The procedure is performed under anesthesia. Transcranial magnetic stimulation , on the other hand, uses alternating magnetic fields instead of electrical currents to stimulate targeted areas of the brain. Seizures are not induced with the procedure and no anesthesia is required.

    Both treatments are FDA-approved but are generally reserved for treatment-resistant depression. By changing chemistry in the brain, namely the level of certain neurotransmitters, these treatments aim to reduce the severity of depressive symptoms.

    For care to be covered, it must be sought at a Medicare-approved facility and must meet certain criteria to meet local requirements for coverage. Before seeking treatment, find out what those criteria are to avoid paying all costs out of pocket.

    Recommended Reading: Does Plan N Cover Medicare Deductible

    Despite Progress Patients Still Struggle With Insurance Coverage For Eating Disorder Treatment

    Young blonde woman meditating in the park

    getty

    As a college student in Michigan, Anna Zaleski became so sick with anorexia that her local providers could no longer treat her she needed round-the-clock care. She flew to Colorado to check into a residential eating disorder treatment program and begin a long process of recovery.

    Despite advocacy from the facility and her parents tireless efforts, her insurance only approved three out of nine weeks of her stay. Her parentsa high school teacher and a CPApaid the rest, nearly $40,000 out-of-pocket, along with tens of thousands of dollars for years of subsequent outpatient therapy.

    Losing the insurance battle didnt just take a dent out of her parents finances, it was also disheartening and demotivating for Zaleski.

    I felt like for some reason, Im not worthy of this treatment, Zaleski said. If my insurance company doesnt even want to fight for me, then why do I want to fight for myself?

    Now nine years later, she knows how lucky she was that her parents could pay and valued her recovery above all else. It breaks her heart that not everyone has the same opportunity.

    If I hadnt gone to treatment, I question if I would really be alive today, Zaleski said.

    Cisco Appears On Track For Net Zero Emissions Releases 2022 Purpose Report On Sustainability Goals

    Eating disorder hospitalizations average 14 days and $19,400the longest and costliest mental and/or substance use disorder admissions.

    Subacute residential treatment like Zaleskis typically lasts longer. The STRIPED report suggests the average residential facility stay is 31 days and costs more than $1,200 per day.

    Due to mental health parity laws and other consumer protections, coverage for eating disorder treatment facilities must be on par with skilled nursing facilities.

    These regulations have improved insurance coverage, according to Cyndi Eddington, vice president of Revenue Cycle Management at Eating Recovery Center . When ERC was founded in 2008, Eddington said nearly every patient faced health insurance exclusions for residential treatment or for eating disorders as a covered diagnosis. Today, we almost never see it, she said

    Despite improvements, insurance barriers remain.

    Insurers wont authorize residential treatment until the patient arrives at the facility for in-person evaluation. But there are fewer than 1,500 residential beds across the U.S. for adults and many patients must travel out of state to get care.

    If the facility determines that the patient needs 24-hour care, the insurer may still deny the admission. That leaves patients and families in a bad spot, according to attorney Lisa Kantor, a long-time advocate for insurance coverage of eating disorder treatment.

    Even with insurance coverage, out-of-pocket costs can be prohibitive.

    Don’t Miss: Is Oral Surgery Covered Under Medicare

    Medicare Coverage For Eating Disorders

    Anorexia nervosa, bulimia nervosa, and binge-eating disorder are complex psychiatric conditions associated with food restriction, purging behaviors , and/or food binging. Not only do they take a toll on mental health, they can lead to malnutrition and medical complications. Reports show one person dies from an eating disorder every 52 minutes.

    Eating disorders are not limited to young women. They affect men and older adults too. As many as 13% of women over 50 years old demonstrate eating disorder behavior.

    Similar to depression, treatment for eating disorders can include medications, psychotherapy, and hospitalization. Effective treatment often requires a team-based approach to meet the psychiatric and physical impacts of the condition.

    Nutrition education, meal planning, and medical monitoring become important to assure adequate nutrition during recovery. Dental care may be especially important if repeated binging has damaged the teeth. Unfortunately, Medicare does not cover routine dental care.

    Residential treatment programs aim to provide integrated care under one roof. These programs are intended for people who are medically stable but who require daily assessments and 24-hour support.

    There are limited eating disorder centers nationwide that accept Medicare for payment and placement is not guaranteed even when it is. If a pre-authorization is denied, it may be time to seek an appeal.

    How To Review And Renew A Plan

    CMS Chief Brooks

    You must review treatment and management plans after every 10 psychological treatment services.

    Eating disorder plans expire after 12 months. You must renew a plan before your patient can access further psychological or dietetic treatment services.

    The table below shows the 12 month cycle of treatment items and reviews process.

    You May Like: Do Medicare Advantage Plans Cover Home Health Care

    How To Verify Insurance Coverage For Eating Disorders

    With three outpatient eating disorder treatment clinics in Tennessee, Athena Care is in-network with most major insurance plans. Filling out our free and confidential online insurance verification form is the best method to determine your eating disorder health insurance coverage details.

    Allow our highly qualified care coordinators to handle the hassles of contacting your insurance company for more information about eating disorder insurance coverage. A care coordinator will check your insurance and thoroughly explain your options after youve submitted the form. Rest assured that all information shared and discussed is kept private.

    Getting Treatment Without Health Insurance

    Eating disorder treatment is notoriously expensive. For many patients, this is a huge barrier. However, there are other options:

    • Community mental health centers: Low-cost counseling centers can provide treatment but may lack providers with specialized training.
    • Family-based treatment : Adolescent eating disorder treatment is sometimes an alternative to more costly residential treatment for teens. In FBT, a lot of the treatment is shifted to parents, who are charged with renourishing their teen and interrupting eating disorder behaviors.
    • Support groups: These provide support to those who are unable to access treatment. The National Eating Disorder Association has a list of low-cost options including support groups.
    • Treatment scholarships: Scholarships are provided directly by some treatment centers. Project Heal is an organization that provides treatment scholarships to various treatment centers around the country.
    • University research programs: You may find low-cost treatment in exchange for participation in clinical research. Reach out to major research universities and inquire about studies.
    • Web-centered: Online, app-centered, and workbook-centered self-help and guided self-help options can be helpful as well.

    The Alliance for Eating Disorder Awareness has an interactive treatment finder tool that includes eating disorder treatment options at all levels of care. You can also search for programs that accept Medicare and Medicaid.

    Read Also: Is Unitedhealthcare Part Of Medicare

    Insurance Accepted By Walden Behavioral Care

    Walden Behavioral Care is in-network with many major insurance/managed care companies. For more information, or to have your benefits checked, please call admissions at 888-305-2997.

    Many plans have co-payments, co-insurance, and deductibles.

    Insurance companies require a demonstration of medical necessity before they will authorize treatment, even though the treatment is a benefit covered under the members contract. Our admissions team will assess medical necessity and make a recommendation about treatment. If the insurance company agrees with our recommendation, the admission will be approved, including the type of service and the number of days authorized for your care. If the insurance company disagrees with our recommendation, it will deny the admission and recommend an alternative level of care. In these situations, the Walden clinician will request an appeal of the decision. This appeal may take days to complete. In such cases, you may elect to pay for the admission recommended by Walden Behavioral Care. A deposit will be required prior to admission. If the insurance company overturns the denial, we will promptly refund your deposit.

    Eating Disorder Medicare Items

    Special Report: Eating disorder services under ‘constant pressure’ after COVID lockdown

    In Australia, people experiencing an eating disorder are eligible for mental health and dietetic support through Medicare. The information on this page is relevant to people seeking treatment for an eating disorder and for health professionals. It outlines the various supports available through Medicare, including specific care and treatment plans, referrals, and overlap between care and treatment plans.

    Recommended Reading: Is Upmc For You Medicare Or Medicaid

    How Much Does Eating Disorder Treatment Cost

    Treatment might range from a few sessions with a therapist to an inpatient hospital stay. The most expensive option is to remain in a hospital or a residential institution.

    A two-week inpatient hospital stay for eating disorders treatment can cost more than $19,000 without insurance. A one-month stay in a residential institution with rigorous therapy costs more than $1,200 each day.

    Some of the above expenses may be covered if you have eating disorder insurance coverage. Individual costs for visits to physicians, therapists, dietitians, therapy sessions, and drugs are often included in outpatient care. In addition, some treatment facilities allow a sliding scale payment plan.

    More articles

    Popular Articles