NEDA TOOLKIT for Educators
Health Insurance Reform for Consumers Federal law
has provided to consumers some valuable — though
limited—protections when obtaining, changing, or
continuing health insurance. Understanding these
protections, as well as laws in the state in which one
resides, can help with making more informed choices
when work situations change or when changing health
coverage or accessing care. Three important federal
laws that can affect coverage and access to care for
people with eating disorders are listed below. More
information is available at www.cms.hhs.gov
• Consolidated Omnibus Budget Reconciliation
Act of 1985 (COBRA)
• Health Insurance Portability and Accountability
Act of 1996 (HIPAA)
• Mental Health Parity Act of 1996 (MHPA)
Health Maintenance Organization (HMO) A health
plan that employs or contracts with primary care
physicians to write referrals for all care that covered
patients obtain from specialists in a network of
healthcare providers with whom the HMO contracts.
The patient’s choice of treatment providers is usually
limited. Hematemesis The vomiting of blood.
Hypnobehavioral Therapy A type of behavioral
therapy that uses a combination of behavioral
techniques, such as self-monitoring to change
maladaptive eating disorders, and hypnotic techniques
intended to reinforce and encourage behavior change.
Hypoglycemia An abnormally low concentration of
glucose in the blood.
In-network benefits Health insurance benefits that
a beneficiary is entitled to receive from a designated
group (network) of healthcare providers. The “network”
is established by the health insurer that contracts with
certain providers to provide care for beneficiaries
within that network.
Indemnity Insurance A health insurance plan that
reimburses the member or healthcare provider on a
fee-for-service basis, usually at a rate lower than the
actual charges for services rendered, and often after a
deductible has been satisfied by the insured.
Independent Living Services Services for a person
with a medical or mental health-related problem who
is living on his/her own. Services include therapeutic
group homes, supervised apartment living, monitoring
the person’s compliance with prescribed mental and
medical treatment plans, and job placement.
Intake Screening An interview conducted by health
service providers when a patient is admitted to a
hospital or treatment program.
International Classification of Diseases (ICD-10) The
World Health Organization lists international standards
used to diagnose and classify diseases. The listing
is used by the healthcare system so clinicians can
assign an ICD code to submit claims to insurers for
reimbursement for services for treating various medical
and mental health conditions in patients. The code is
periodically updated to reflect changes in classifications
of disease or to add new disorders.
Interpersonal Therapy (IPT) A type of therapy
designed to help people identify and address their
interpersonal problems, specifically those involving
grief, interpersonal role conflicts, role transitions, and
interpersonal deficits. In this therapy, no emphasis is
placed directly on modifying eating habits. Instead, the
expectation is that the therapy will enable people to
change as their interpersonal functioning improves.
IPT usually involves 16 to 20 hour-long, one-on-one
treatment sessions over a period of four to five months.
Ketosis A condition characterized by an abnormally
elevated concentration of ketones in the body tissues
and fluids, which can be caused by starvation. It is a
complication of diabetes, starvation, and alcoholism.
Level of Care The care setting and intensity of care
that a patient is receiving (e.g., inpatient hospital,
outpatient hospital, outpatient residential, intensive
outpatient, residential). Health plans and insurance
companies correlate their payment structures to the
level of care being provided and also map a patient’s
eligibility for a particular level of care to the patient’s
medical/psychological status.
Major Depressive Disorder or Major Depression A
condition characterized by one or more major
depressive episodes that consist of periods of two
or more weeks during which a patient has either a
depressed mood or loss of interest or pleasure in nearly
all activities.
Mallory-Weiss Tear One or more slit-like tears in the
mucosa at the lower end of the esophagus as a result of
severe vomiting.
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