The following blog post is sponsored by HealthSherpa.
20 million women and 10 million men suffer from an eating disorder at some point during their life. Eating disorders are serious but treatable illnesses that can affect anyone. In 2014, it became less challenging for someone with an eating disorder to access care.
Thanks to the Affordable Care Act (ACA), healthcare has been expanded to many people who historically didn’t have insurance. The ACA prohibits insurance companies from denying coverage for pre-existing conditions, including eating disorders, and provides coverage for young adults under their parent’s insurance. Plus, every plan must offer essential health benefits—free preventive care, hospitalization, mental health services, plus more.
If you’re looking to enroll in health coverage, we know the process can be overwhelming. In this article, we’ve included the most common questions that come up when shopping for a new health insurance plan:
What questions should I ask when choosing a plan?
If you are seeking or currently in treatment for an eating disorder, here are some questions to ask before enrolling in coverage:
- Does my current physician (primary care doctor, cardiologist, etc.) accept this plan?
- Will seeing a psychiatrist or psychologist be covered?
- Will I have access to a dietitian?
- Will this plan cover specialists and if so how often can I see them?
- Will I need any prescriptions?
- Will I need an in-patient treatment program?
- Will I need any x-rays, labs, or other tests?
However, it’s important to know that specific behavioral health benefits will depend on your state and the health plan you choose. Each state adopted its own benchmark plan that may include or exclude coverage for eating disorders, and the exact benefits may differ. That benchmark is used to determine the benefits per plan sold in that state.
When choosing a plan, make sure to look through the following plan components:
- Summary of benefits to see which services are included
- Drug formulary to determine if a prescription you need is covered
- Provider list to see if a specific doctor or specialist accepts this plan
Answering these questions will help you determine what’s covered and how much you can expect to pay throughout the year.
What services are included in every plan?
Every plan under the ACA comes with essential health benefits. These include:
- Blood pressure screening
- Depression screening
- Diabetes (Type 2) screening
- HIV screening
- Immunization vaccines
- Well-woman visits to get recommended services
Plus, there are also quite a few mental health services included:
- Behavioral health treatment, including psychotherapy and counseling
- Inpatient services for mental and behavioral health
- Treatment for substance use disorder, commonly referred to as substance abuse
- Rehabilitative and habilitative support services for people with behavioral health challenges
You can also find a list of preventive care services included in every ACA plan here.
Once I enroll, how can I take advantage of my coverage?
After you have enrolled in a plan, you can use it for services like:
- Filling a prescription at the pharmacy
- Getting emergency care
- Going to the doctor
- Annual visits for women
- Depression screening
Eating disorders treatment must address both the psychological and physical aspects of the specific disorder. Whether you have insurance already or not, you’ll want to get a full assessment and diagnosis in order to start your treatment. You can make an appointment with a physician or therapist you trust to find out how to get a full assessment and diagnosis and to get appropriate referrals to professionals specializing in the treatment of eating disorders. The assessment should consider all related physical and psychological problems so you can work with your healthcare providers to develop the best plan for treatment, as well as use the benefits you are entitled to under your plan.
Once you have a multidisciplinary treatment plan in place, it’s important to get educated about your eating disorder, treatment options, and health coverage. When you shop for a plan, you should take this into consideration ahead of time. If you are already insured when you get your treatment plan, make sure to read the detailed description of your health coverage benefits to find out what’s covered and for how long.
What can I do if my insurance denies a service?
If you see your doctor or visit a hospital for a specific service and your health insurance doesn’t pay, you can ask that your insurance reconsider its decision. The ACA ensures you have the right to appeal the decision and have it reviewed by an independent third party.
Your health insurance company must first notify you to explain why they denied your coverage. Make sure you understand the reasons for the denial and ask the insurance company for the reason in writing if a written response has not been received. They also must let you know that you can appeal their decision.
If you speak with the insurance company you’ll want to document everything. We commonly hear from legal and insurance professionals, “If you don’t document it, it didn’t happen.” So, we recommend you document every interaction, including the time and date of the call, the name of the person with whom you spoke, their contact information, and what was discussed during the conversation.
Don’t forget to shop and compare 2019 health insurance plans this Open Enrollment. It’s only a short six week period, from November 1st to December 15th. Make sure to mark your calendar! If you miss this window, you may have to wait a full year to enroll.
Ricky Phipps is a Consumer Advocate and licensed health insurance agent at HealthSherpa. If you’re looking for quality, affordable health insurance, Ricky, along with the HealthSherpa team, can help you find the best option for your needs. You can reach out to Ricky at (855) 699-7137 — or grab a quote here.