Despite advances, patients still struggle to obtain insurance coverage for the treatment of eating disorders

As a college student in Michigan, Anna Zaleski became so ill with anorexia that her local providers could no longer cure her; she needed 24 hour care. She flew to Colorado to enroll in a residential eating disorder treatment program and begin a long process of recovery.

Despite the institution’s advocacy and the tireless efforts of his parents, his insurance only approved three of the nine weeks of his stay. Her parents, a high school teacher and CPA, paid the remainder, nearly $ 40,000 out of pocket, as well as tens of thousands of dollars for years of subsequent outpatient therapy.

Losing the insurance battle didn’t only rock his parents’ finances, it was also disheartening and demotivating for Zaleski.

“I felt like, for some reason, I didn’t deserve this treatment,” Zaleski said. “If my insurance company doesn’t 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 luck.

“If I hadn’t had treatment, I wonder if I would really be alive today,” Zaleski said.

The cost of eating disorders

Almost 29 million Americans suffer from an eating disorder in their lifetime – 5.5 million in any given year – at an annual cost of $ 4.6 billion to the health care system , according to a strategic training initiative for the prevention of eating disorders (STRIPED) report of the National Academy of Eating Disorders. The societal costs of lost productivity, government support and unpaid care are much higher.

Average hospitalizations for eating disorders 14 days and $ 19,400– the longest and most expensive admissions for mental disorders and / or drug addiction.

Subacute residential treatment like Zaleski’s usually lasts longer. The STRIPED report suggests that the average stay in a residential facility is 31 days and costs over $ 1,200 per day.

Due to mental health parity laws and other consumer protection, coverage of eating disorder treatment facilities should be comparable to that of skilled nursing facilities.

These regulations have improved insurance coverage, according to Cyndi Eddington, vice president of Revenue Cycle Management at Food recovery center (ERC). When the ERC was founded in 2008, Eddington said almost all patients were excluded from health insurance for residential treatment or for eating disorders as a covered diagnosis. “Today you hardly ever see it,” she said.

Despite the improvements, barriers to insurance remain.

Insurers will not allow residential treatment until the patient arrives at the facility for an in-person assessment. But there is less 1,500 residential beds across the United States for adults and many patients must travel out of state for care.

If the facility determines that the patient requires 24-hour care, the insurer can still refuse admission. It leaves patients and families in dire straits, lawyer says Lisa Kantor, a longtime advocate for insurance coverage for the treatment of eating disorders.

“It’s disheartening,” Kantor said. “For many of these women, it takes so much energy for the whole family to get them to the point where they are ready to accept help.

Some families pay out of pocket while they appeal the denial of insurance, but many cannot afford to do so.

Eddington said the ERC is working hard to avoid surprise insurance denials, working with families to develop contingency plans, such as partial hospitalization– if the insurance refuses admission. ERC is also going to the mat with insurance for patients and offering financial assistance to underinsured patients in need.

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

“For some people who need treatment, their deductible and coinsurance are unrealistic expenses,” Eddington said. “$ 5,000 might as well be $ 100,000 if you can’t afford to cover it and you don’t have a safety net.”

Become sicker

When insurers deny coverage for 24-hour residential services or withdraw it through a use review process, the message to patients is clear: you are not sick enough to be treated.

It’s a dangerous message for patients with eating disorders, according to Zaleski.

She received this message during a second residential stay following a relapse when the insurer interrupted her coverage a few days after the start of her stay. The insurer interpreted Zaleski’s compliance with the treatment plan as a sign that she was not sick enough to need 24 hour residential care. She took it as a challenge to prove how bad she was. really sick.

“We will never question paying for someone’s cancer treatment, even if they have stage I or stage II [cancer]”Zaleski said. Nobody tells cancer patients to come back when their cancer has become stage IV.” With mental health, we want to see someone in such a dark place before we want to pay for it.

At this point, Zaleski noted, patients are sicker, more difficult to treat, and require more expensive treatment, if they can be treated at all. More … than 10,000 in the United States, people with eating disorders die every year.

Parity in mental health and beyond

Shame and fear of future discrimination prevent some families from seeking treatment, as does misinformation, according to Eddington.

“There are still families who believe they don’t have mental health coverage,” Eddington said.

This National Eating Disorders Awareness Week, she wants patients and their families to know that help and resources are available. Eddington has seen tremendous progress and more work to do.

The next frontier for ensuring access to mental health care goes beyond parity with medical coverage. A recent california law requires insurers to cover all medically necessary mental health services, according to American Psychiatric Association Guidelines rather than the internal policies of insurers. Wider adoption of such a law would put mental health experts and clinicians in charge of deciding what kind of care patients need.

“There is really a problem when we have insurance companies dictating treatment, as opposed to real professionals dealing with clients who should be advising and guiding treatment,” Zaleski said.

The pain of seeing his parents fighting for insurance coverage while fearful of having to bury him still irritates Zaleski. She would never wish an eating disorder on her worst enemy, but believes direct experience could make insurance companies more generous.

“If everyone were to go through what families like mine had to go through, then the insurance coverage would be different. “

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Justin D. O'Neill