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NEDA TOOLKIT for Parents Ask the insurer whether they will “flex the benefit.” Negotiate with the treatment center about the cost of treatment. Flexing benefits means that the insurer applies one type of benefit for a different use. For example, medical benefits might be “flexed” to cover some aspect of mental health treatment— usually inpatient treatment. Also, inpatient benefits might be flexed (traded) to substitute intensive outpatient care for inpatient care—for example, 30 inpatient days for 60 intensive outpatient benefit days. Substance abuse (also called chemical dependency) benefits might be traded for additional benefits to treat the eating disorder if the beneficiary thinks he/she will never need the substance abuse benefits available under his/ her coverage. There is a clinical rationale for doing this: if the eating disorder is not treated appropriately from the outset, the insurer risks incurring additional and higher costs for patient care in the future because further hospitalization and treatment may be needed. By flexing inpatient medical benefits or trading inpatient days for outpatient days to obtain more days of mental health treatment, future and possibly higher healthcare expenses might be avoided. While insurers are not obligated to do flex benefits, they may respond to a sound, logical argument to do so if it makes good sense from both a business and patient care perspective in the longer term. If you can support this argument with your doctors’ recommended treatment plan and clinical evidence from practice guidelines and an evidence report, the insurer may agree. Our survey of treatment centers indicates that some treatment centers have a sliding fee scale and may adjust the treatment charges or set up a payment plan for the patient’s out-of pocket costs. Discuss with the insurer how existing laws and clinical practice standards affect your situation. Educate yourself about how the state’s mental health parity laws and mandates apply to the patient’s insurance coverage. Also ask the insurer if it is aware of evidence reports on treatment for eating disorders and guidelines like the American Psychiatric Association’s clinical guidelines for treating eating disorders: www.psych.org. Ask what role the evidence plays in the decision about benefits. As a last resort, some patients or their advocates may also contact the state insurance commissioner, state consumer’s rights commission, an attorney, the media, or legislators to bring attention to the issue of access to care for patients with eating disorders. If the patient is employed or in a union, consider asking the employer (or its human resources manager) or union representative to negotiate with the insurer about aspects of the coverage policy that seem open to interpretation. As a client of the insurance company, the employer is likely paying a lot of money to provide benefits to employees (even when employees pay part of the insurance premiums). Because insurance companies want to maintain good business relationships with their clients, the employer may have more influence than the patient alone when negotiating for reimbursement. Many patients or families of patients are afraid or embarrassed to discuss bulimia or anorexia with an employer. Remember that legally, a person cannot be fired and insurance cannot be dropped solely because of having an eating disorder (or any other health condition). Page | 84