NEDA TOOLKIT for Parents
Steps to maximize insurance benefits
Educate yourself
Read the other information in the Parent Toolkit to
learn about eating disorders, treatment, current
clinical practice guidelines, and how you can best
advocate for and support the family member who has
an eating disorder. Refer to the latest evidence-based
clinical practice guidelines in this toolkit and have
them in hand when speaking to your health plan
about benefits. Be prepared to ask your health plan
for the evidence-based information they use to create
their coverage policy for eating disorders.
Find out if your state has a mental health parity law or
mandate and what the terms of that law or mandate
are. Mental health parity simply means that your
insurance company must not limit mental health and
substance abuse healthcare by imposing lower day
and visit limits, higher copayments and deductibles,
and lower annual and lifetime spending caps than
they do for medical care. The website
www.bulimiaguide.org has detailed information about
which states have mental health parity laws or
mandates and what those laws and mandates cover.
See the Eating Disorders Coalition for Research, Policy
& Action web site for how to get involved in the effort
to influence federal policy at:
www.eatingdisorderscoalition.org. Get organized
If a patient’s first encounter with the healthcare
system is admission to an emergency room for a life-
threatening situation with an eating disorder, whoever
is going to deal with insurance issues on the patient’s
behalf will need to get organized very quickly to
figure out how to best access benefits. Patients who
are seriously medically compromised will likely be in
the hospital for a few days before discharge to
outpatient care or a residential eating disorder center.
Those few days are critical to negotiating
reimbursement for the longer-term care.
If the situation is not an acute emergency and you
want to find a treatment center, consider whether you
have authority to act on the patient’s behalf or
whether the patient must give you written authority to
act on his/her behalf. If a child is 18 years of age or
older, parents will need the child’s written permission
to act on the child’s behalf. Healthcare providers have
forms that require signatures to allow free flow of
communication and decision making.
A spouse, partner, friend, or other person who wants to
act on behalf of the patient will need to have the
patient sign appropriate authorizations. Medical
confidentiality is discussed later in this section.
Read the patient’s entire insurance benefits
manual carefully to understand the available
benefits 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:
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.
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