Eating disorders can be both medically and financially
devastating. The National Eating Disorders Association says as many
as 10 million women and 1 million men in the U.S. battle anorexia
or bulimia, and another 13 million more struggle with binge eating
or an obsession with dieting. Worse, kids as young as 8 and 9 are
being diagnosed with eating disorders and adolescent girls are
still the No. 1 demographic for developing an eating disorder.
According to the National Eating Disorders Association, anorexia
has the highest mortality rate of any mental illness. So you may be
surprised to know that health insurance companies often don't
treatment for eating disorders
A 30-day stint at a residential treatment center for eating
disorders can cost up to $30,000.
"And 30 days is usually the limit set by insurance companies, if
they cover it at all," says Lynn Grefe, president and CEO of the
National Eating Disorders Association.
People do stay longer but they either self-pay or fight their
insurance company for coverage. Grefe often talks to parents who
are fighting insurance companies for another day or another week of
treatment. Yet the same insurer is unlikely to kick a child with
leukemia out of the hospital at the 30-day mark, she says.
"Not too long ago insurance companies didn't cover much for
autism because there was such a stigma about it," says Kathleen
MacDonald, an eating disorders educator and policymaker at Kantor
and Kantor and education coordinator of the F.R.E.E.D. Foundation,
a nonprofit advocacy group that battles eating disorders. "When
enough people came out of the closet and said, 'This is not because
I was a bad mother, this is a disease and my family deserves
treatment,' insurance companies listened."
Why the disparity?
The lack of insurance coverage may be attributed to the wide
variety of treatment options.
Some patients need residential care, others need outpatient
care, and still others whose bodies have been impaired medically
need physical treatment in the hospital. Often patients need some
follow-up care for months or years, and many patients relapse. The
nature of both the physical and mental component of eating
disorders makes them one of the most complex mental disorders to
treat, says Grefe.
Some health insurers don't cover eating disorders at all, trying
to minimize their risk of an expensive health problem. Others cover
a 30-day residential treatment and/or some outpatient therapy with
an eating disorder specialist or psychiatrist, but often with a
lifetime limit on visits.
In addition, when insurance companies do cover treatment, they
often base "wellness" on the person's body mass index (BMI), not on
the psychiatric care needed after the patient reaches the required
Insurers can also refuse coverage if a patient's BMI is not low
enough. The Federal Substance Abuse and Mental Health
Administration determined that a BMI of 17.5 is a "strict
indicator" of anorexia, yet some insurers require patients to have
a BMI of less than 15 to qualify for residential treatment, says
According to BMI calculators, a 5-foot-5-inch woman would weigh
106 pounds with a BMI of 17.6. The same woman would weigh 90 pounds
with a BMI of 15.
Yet patients and doctors are left to play an insurance "game" in
hopes of scoring treatment coverage. Because eating disorder
treatment is covered more fully when physical symptoms are the
priority, if someone is seriously underweight they often don't want
the doctor to document it as an eating disorder (meaning a mental
disorder) because they'll get better coverage under a physical
"You save them physically but don't do anything to help the
mental side of it," says Grefe.
"If you want an insurance company to pay, you need to get them
to treat the symptoms," says Katherine Woodfield, a New
Jersey-based insurance broker. "In some cases, keeping the patient
alive and getting the weight on is part of the battle. The mental
illness component still exists, but if you want insurance to pay,
they need a physical problem."
MacDonald finds this frustrating. She got an email from a mom
whose daughter reached 60 percent of her ideal body weight and the
insurance company said she was fit to be released from care.
"It makes no sense," MacDonald says. "We wouldn't do that to
people with cancer, right? We wouldn't say, 'Well your tumor is
still present, but it's down to 90 percent instead of 100 percent
so good luck to you.' Yet every single day insurance companies use
their 'medical necessity' criteria to dole out treatment and make
and life and death decisions for people with eating disorders."
Grefe knows of patients who have to go home and lose more weight
and get sicker in order to get treatment. She compares it to
saying, "You only fractured your leg, come back when it's really
Changing the health insurance system
Federal law tried to address these issues. The
Wellstone-Domenici Mental Health Parity Act of
ensured that employers with 50 or more employees, and whose group
health coverage included mental illness, had to include coverage
for treatment of eating disorders. But experts say the law lacks
specifics and leaves it up to each state and insurer to provide the
coverage or lack of it as they see fit.
In order to get
coverage for eating disorder treatment or extended benefits on a
plan that offers some coverage, patients should:
- Ask the insurer to 'flex the inpatient benefit.' If you have
outpatient benefits but no residential treatment coverage, the
insurance company may let you swap coverage to help pay for a
- Appeal to the medical director of the insurer if you are
- If you have an employee health plan, speak to your employer,
union, or human resources department. Since the employer pays for
all or part of your coverage, it can pressure the insurer to
provide the needed service.
- Have your physician or specialist write a letter documenting
the level of care needed.
- If services are clearly excluded from your policy, a letter
to the company's medical director documenting the need for
treatment and risks of not receiving it may help the company
re-examine its policy.
- Consider self-pay while you pursue reimbursement
- Write to the state insurance department or the Department of
Labor, which regulates self-insured plans.
- Speak to an attorney to determine if you have a legal