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NEDA TOOLKIT for Parents Medical benefits coverage also often comes into play to treat 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. Keep careful and complete records of communications with the insurance company and healthcare providers for future reference as needed From the first call you make, keep a complete record of your conversation. Treatment often occurs over a long period of time. Maintaining a log book—whether computerized or in hard copy—can be important for future reference if there are questions about claims. Decide where all notes and documentation will be kept for easy access. Create a back-up copy of everything, and keep it in a safe and separate place. The record log of conversations should contain the following: Notes taken of each conversation with an insurer or healthcare provider Date, time, name, and title of person with whom you spoke Person’s contact information As a courtesy, you may wish to let the people you talk with know that you are keeping careful records of your conversations to help you and the patient remember what was discussed. If you decide to tape record any conversation, you must first inform and ask the permission of the person with whom you are speaking. Call the insurer to discuss benefits options With documentation of the patient’s diagnosis and proposed care plan in hand, it’s a good idea to call the insurance company before the patient formally enters a treatment program. Quite often, preauthorization for a treatment facility or healthcare provider is needed. Ask for a case manager who has credentials in eating disorders. This will improve your chance of getting one contact person to talk with over the longer term of treatment who better understands the complexities of treatment. 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 person you speak with 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. Don’t assume one department knows what the other department is doing. Copy communications to all the departments, including health, mental health, enrollment, and other related departments. Don’t panic when and if you receive the first denial. Typically, a denial is an automatic computer-generated response that requires a “human override.” Often you need to go up at least one level, and perhaps two levels, to reach the decision maker with authority to override the automated denial. Your insurance company only knows what you and the treating professionals tell them. Make sure they have all information necessary to make decisions that will be of most benefit to you or your loved one. Make no assumptions. Your insurance company is not the enemy – but may be uninformed about your case. Treat each person as though he/she has a tough job to do. Page | 71