Eating Disorders ~

[sylvie]

Originally Posted by ArkansasPiscesGrrl

[SIZE="4"]In reading some of the notes in this thread this morning (kudos and much love to all who have posted!), I could not help but notice the discussion of people's struggles in getting insurance benefits for treatment. I hope I may be able to shed a little light on the topic, and perhaps in doing so, others may decide to try to get the help that is out there!

I have been in the medical insurance and billing field for over 25 yrs. For the past 5 yrs, in fact, I have been involved with the Billing Operations for several Eating Disorder treatment facilities across the nation. I have seen huge changes in the availability of benefits , even in that short amount of time. Wonderful strides have been made in the viewpoint of benefits for mental health treatment.

One of the biggest changes is in the Federal Mandates in place for Parity in the treatment of mental health. What that means is , it is now recognized that most insurance plans in this country are now required to view certain mental health diagnosis just the SAME as they would any other medical condition. IE: if the insurance plan offers unlimited office visits for a medical diagnosis such as diabetes or allergies or whatever, they CANNOT then place a limit on office visits for a severe mental illness. No longer can they limit by days, nor on the amount of benefits being paid out.

The major diagnosises covered under the Federal Parity Laws include Anorexia and Bulimia. In some states, they also include ED NOS (Eating Disorders Not Otherwise Specified, sometimes a catch-all for the ED spectrum) The parity laws also usually cover Major Depressive Disorder, and some others.

Not all insurance plans are included in the Federal Mandates, so you should contact your plan's Member Services to see if yours does. Generally speaking, if you have an Individual plan (as opposed to a Group plan) or if your group plan (usually from an employer) is considered a small group plan of under 50 employees), it may not meet the Parity criteria. But even if it does NOT meet the criteria, many forward-thinking plans have begun to offer unlimited benefits for this help.

In any case, I urge anyone who is holding back from looking for help because of fears of whether their insurance might cover the costs, to please contact their plan. Many state insurance plans are also beginning to offer benefits for their members (Medicaid, etc). Yeah, you might have to jump through some hoops, but it is worth it! And also, there are more and more treatment options becoming available, from Inpatient and Residential, to Partial Hospitalization (usually 6-8 hrs a day), to Intensive Outpatient (usually 4-5 hrs per day) to OP. Many facilities are contracted with Medicaid or State-sponsored plans.

I am so blessed to be involved with these programs. I have helped to develop program content for 3 separate facilities, so I know the different types of therapeutic options that are out there.

On a personal note, I have dealt with my own ED behaviors since I was about 4 yrs old. My heart goes out to all who suffer the daily struggles. I know it IS a daily fight, and a daily reprieve. /SIZE]

Thank you so much for posting this..
Although i am in Canada, and i know everything works a bit differently here..
i certainly am not giving up the fight & your post encourages me to keep trying, i know there has to be something, ANYthing somewhere for me.. i have an appt with my doctor coming soon, and i know i can get some help if she would just refer me, and i will push her on this.. She is very difficult to get to sit and listen, she's so anxious to push people out the door and bring someone else in.. i dislike that, very much. As for my health benefits through work, they only cover 4 sessions, which is SOMEthing, but just not enough.. i used my 4 sessions this year already, and when i was going it helped me so very much.. But, once my sessions ended, she referred me to Mental Health for further counselling, figuring that they had some sort of counselling program to offer..

Mental health is of no cost here, that's where i first tried but surprisingly, they have nothing at all to offer (counselling included) with eating disorders.. They do in other cities etc, just no one here where i live.. The resources here are very, very little.. Another place that does offer counselling, charges 75 dollars a session, once a week..

If i were to pay on my own, then i know i simply just could not afford it.. So right now, i'm working on a referral from my doctor, then hopefully i can either find something that will be fully covered, or maybe even if my work benefits would cover half at least.. Anything helps..

i'm not giving up, because after the week i had last week, it proved to me just how fragile i can be, and how easy i could go back to old habits.. Though i fought my way through it, it was a highly emotional week for me and i know counselling would be such a blessing right now...i have all my other tools in place and use them all daily - but i need this..

*crossing fingers*

Hope you all have an easy week this week.. ((((BIG huggggz))))