NEDA TOOLKIT for Parents
Be aware that if the patient is a college student who
had to drop out of school to seek treatment and was
covered by school insurance or a parent’s insurance
policy, the student may no longer be covered if not a
full-time student. While many people will continue
working or attending school, some cannot. If this is the
case, it’s important to understand what happens with
insurance. Most insurance policies cover students as
long as they are enrolled in 12 credit hours per
semester and attend classes. Experts in handling
insurance issues for patients with eating disorders
caution that patients who have dropped out of school
should avoid trying to cover up that fact to maintain
benefits, because insurance companies will usually
find out and then expect the patient to repay any
benefits that were paid out.
If coverage has been lost, the student may be eligible
to enroll in a Consolidated Omnibus Budget
Reconciliation Act (COBRA) insurance program.
COBRA is an Act of Congress that allows people who
have lost insurance benefits to continue those benefits
as long as they pay the full premium and qualify for
the program. See www.cobrainsurance.com for more
information. A person eligible for COBRA has only 30
days from the time of loss of benefits to enroll in a
COBRA plan. It is critical that the sign up for COBRA be
done or that option is lost. Be sure to get written
confirmation of COBRA enrollment from the plan. If
the student is not eligible for COBRA, an insurance
company may offer a “conversion” plan for individual
coverage. If the patient is in the hospital and will be discharged
to a residential treatment center, discuss how the
medical and behavioral health components of
benefits will work. Although a patient may be
“medically stable” at discharge, he/she may not be
nearly well enough to participate fully in
psychotherapy at the residential center. The patient’s
medical condition, though not life-threatening at this
point, affects mental health and ability to participate
in treatment. Restoring physical health may take days
or weeks. Therefore, before the patient is admitted to
a residential eating disorder center or placed in
outpatient treatment, contact the patient’s health plan
or employer (if applicable and the health plan is self-
funded by the employer) and ask for the early claims
for psychotherapy to be paid under the medical
benefits instead of the behavioral health benefits. The
language to use is: “Will you intercept psychotherapy
claims and pay them under medical benefits until the
patient is stable enough to participate fully and assist
in her treatment?”
Not all health plans will do this, but some do, so it’s
worth asking. Going this route can save the behavioral
health benefits for the time when the patient is better
able to take part in the psychotherapy.
Another way to get the most out of benefits is to find
out whether chemical dependency or substance abuse
benefits are included in the mental health day
allotment or if it is a separate benefit. If it is separate
and the patient does not really need this benefit, find
out whether the insurer will “flex” the benefit to apply
it for treating an eating disorder.
Find out the authorizations for care that the
insurer requires for the patient to access
care. Once insurance benefits are confirmed, be sure to
obtain the health plan authorizations required for
reimbursement for the care the patient will receive.
Sometimes authorizations and referrals are sent
electronically to the concerned parties. Always
confirm that they have been sent and received by the
appropriate parties. Ask for the level-of-care criteria
the patient must meet to be eligible for the various
levels of benefits. Again, keep a record of the
authorizations received.
Communicate with key caregivers to give any
needed input and devise a treatment plan.
Obtain the names of the people who will be providing
care and having daily interactions with the patient
(including lower-level staff such as aides). Try to meet
with, or talk by phone, to each caregiver on the team.
Discuss the diagnosis (and whether there is more than
one primary diagnosis) and treatments options, and
ask whether there is clinical evidence to support the
recommended treatment and what that evidence is.
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