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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. Page | 72