NEDA TOOLKIT for Parents
Read your plan
Document everything
Obtain a copy of the full plan description from the
health plan’s member’s website (i.e., the specific plan
that pertains to the insured), the insurer, or, if the
insurance plan is through work, the employer’s human
resources department. This document may be longer
than 100 pages. Do not rely on general pamphlets or
policy highlights. Read the detailed description of the
benefits contract to find out what is covered and for
how long. If you can’t understand the information, try
talking with the human resources staff at the company
that the insurance policy comes through, with an
insurance plan representative (the number is on the
back of your insurance identification card), or with a
billing/claims staff person at facilities where you are
considering obtaining treatment. If hospital emergency
care is not needed, make an appointment with a
physician you trust to get a referral or directly contact
eating disorder treatment centers to find out how to
get a full assessment and diagnosis. The assessment
should consider all related physical and psychological
problems (other documents in this toolkit explain the
diagnostic or assessment process and testing). The four
main reasons for doing this are:
If you don’t document it, it didn’t happen. It’s a saying
frequently used in the legal and insurance fields alike.
Insurance attorneys recommend documenting every
single contact you have with your loved one’s insurer,
including the time and date of the call, the name of
the person with whom you spoke and their contact
information, and what was discussed during the
conversation. Experts also recommend keeping copies
of all written communication you receive from your
insurance companies, such as denial or approval letters,
explanations of benefits, and more. Some loved ones
have found it useful to organize everything in a folder, a
binder, or electronically.
• To obtain as complete a picture as possible
about everything that is wrong
• To develop the best plan for treatment
• To obtain cost estimates before starting
treatment • To obtain the benefits the patient is entitled
to under his/her contract for the type of care
needed. For example, many insurers provide
more coverage benefits for severe mental
disorder diagnoses. Some insurers categorize
anorexia and bulimia nervosa as severe
disorders that qualify for extensive inpatient
and outpatient benefits, while others may not.
Medical benefits coverage also often comes into play
when treating eating disorder-associated medical
conditions, so diagnosing all physical illnesses present
is important. Other mental conditions often coexist
with an eating disorder and should be considered
during the assessment, including depression, trauma,
obsessive compulsive disorder, anxiety, social phobias,
and chemical dependence. These coexisting conditions
can affect eligibility for various benefits (and often can
mean more benefits can be accessed) and eligibility for
treatment centers.
If you decide to tape record any conversation, you must
first inform and ask the permission of the person with
whom you are speaking.
Confirm with the insurer that the patient has benefits
for treatment. Also ask about “in-network” and “out-of-
network” benefits and the eating disorder facilities that
have contracts with the patient’s insurance company,
because this affects how much of the costs the patient
is responsible for. If the insurer has no contract with
certain treatment facilities, benefits may still be
available, but may be considered out-of- network. In
this case, the claims will be paid at a lower rate and the
patient will have a larger share of the bill.
You may also want to consider having an attorney in
mind at this point in case you need to consult someone
if roadblocks appear; however, avoid an adversarial
attitude at the beginning. Remember to keep complete
written records of all communications with every
contact at your insurance company. Other things to
remember: • Thank and compliment anyone who has
assisted you.
• You’re more likely to receive friendly service
when you are polite while being persistent.
• Send important letters via certified mail to
ensure they can be tracked and signed for at
the recipient location.
• Set a timeframe and communicate when you
would like an answer. Make follow-up phone
calls if you have not received a response in that
timeframe. Page | 45