A Quick Guide to Insurance for Eating Disorder Care

The year is winding down, and now is an ideal time to use insurance benefits before they expire. For many people, however, insurance can be a confusing and overwhelming topic.

There are several common questions referring providers have related to insurance coverage for eating disorder care. In this reference guide, we’ll answer some of these questions, define common insurance-related terms, and provide a brief overview of some insurance companies we work with at The Emily Program.

What Will Insurance Cover?

“Will my insurance cover eating disorder care?” is a question we get quite often. The best person to find answers to this question, however, is the client. It is the client’s responsibility to contact their insurance provider to determine what portion of care will be covered by their specific plan and what portion will be their part to cover. Insurance plans are an agreement between an insurance company and the person insured, so these two parties are the ones equipped to have that conversation.

We have an insurance verification tool on our website that can help guide the client’s conversation with their insurance providers. These phone calls may be anxiety-provoking for some, so having an already compiled list of questions may ease some stress. The tool outlines the questions the client can ask their insurance provider, including some about out-of-pocket expenses and the number of sessions, if any, which may be fully or partly covered by insurance. “What is my deductible?” and “Is there a limit on the number of therapy sessions per year?” are just two of the many questions on the list.  

Various insurance providers cover different areas of health. Some cover behavioral health or mental health (eating disorder treatment, for example), while others focus more on physical health (such as doctor’s visits or hospital stays). The client must contact their insurance provider to know if certain services are covered. If the client is still having issues about getting the information they need, we suggest that they call the insurance company’s “Health Advocate” or “Case Manager,” whose phone number is usually listed on the back of their insurance card.

The Emily Program’s Current Insurance Providers

We have a list of insurance providers with whom we have contracts on our website. The list is subject to change by the insurance companies, but a few companies we currently work with are as follows:

• Minnesota
  • BlueCross BlueShield
  • HealthPartners
  • Medical Assistance
  • Medicare
  • PreferredOne
• Ohio
  • AultCare
  • Humana/LifeSynch
  • Medical Mutual of Ohio
  • OSU Health Plan
  • SummaCare
• Pennsylvania
  • Highmark
  • UPMC
• Washington
  • Amerigroup
  • Community Health Plan of Washington
  • Molina Healthcare
  • Coordinated Care*
  • United Health Care Community Plan*

*In-network coverage in King County

If The Emily Program is not “in-network” under an insurance policy, the client may be able to utilize out-of-network benefits. Eating disorder treatment may take a while and this could lead to authorization challenges. Fortunately, we have working relationships with most insurers, and can often work with them on a course of action.

Insurance Terms and Definitions

With complicated insurance jargon, navigating a contract, or having a conversation with someone from the insurance company, can be difficult. We have a guide on our website that defines terms commonly used when it comes to insurance. A few are below:

• Deductible: the fixed dollar amount that the client pays during the year of the benefit period
• Coinsurance: the percentage that the client pays for their services (often the percentage of responsibility after the deductible has been met)
• Co-pay/co-payment: the dollar amount that the client pays “out of pocket” before their health insurance pays
• Explanation of Benefits (EOB): a document that explains which services are not covered (sent out after a claim has been processed)
• In-Network Provider/Contracted Provider: the healthcare providers who sign a contract with an insurer (in general, in-network providers agree to accept a “discounted” rate of services, an amount based on the client co-pay or the coinsurance)
• Prior Authorization: permission granted for a service in advance by the insurance company

FAQs about Insurance

Questions are common when it comes to insurance coverage for eating disorder treatment. Below are some of the most-asked insurance-related questions that we receive:

• Why aren’t benefits a guaranteed form of payment?
  • The Emily Program checks coverages for all our services against insurance plans as accurately as possible.
  • However, diagnosis code, length/frequency of visits, service location, and treating provider are all variables that impact benefits once a claim is sent.
• Why can’t The Emily Program tell clients exactly how much treatment costs?
  • The total cost is determined by the client’s benefits at the time a service was provided.
  • Many variables determine how much it will cost. This can include network status, out-of-pocket payments, insurance pricing, and The Emily Program’s contract with the insurance company.
  • It is not possible to provide an accurate estimate due to too many variables.
• What’s the difference between primary and secondary insurance?
  • Primary insurance is the “first in line” to pay.
  • If the secondary insurance covers, they may pay if the primary doesn’t cover.
  • Services are billed to both insurance companies.

Clients may have additional comments or questions. In this case, the client should call their insurance company’s Customer Service line, which can be found on the back of their insurance card.

More information can be found on our insurance page. Please call The Emily Program Client Accounts Team with questions regarding the services you have received, clarification on your statement, and payment plan options: 1-888-364-5977, ext. 1357.