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.
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