Get Adobe Flash player
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