Insurance & Payment

Insurance is a very complicated issue. In general, insurance issues may be negotiated and it is best to contact each facility directly to discuss your coverage benefits. Many facilities have staff dedicated specifically to handling insurance claims. These experienced individuals may be able to negotiate coverage for treatment even when their facility isn’t contracted with your insurance provider and/or your benefits seem inadequate.

Single case agreements can be made to cover treatment at out-of-network facilities for a number of reasons. In some cases the contracted rate for an insurance company at an in-network facility may be higher than the cost at a less expensive out-of network facility, making coverage at an out-of-network facility more favorable. Also, certain circumstances such as the need for specialized treatment or geographic constraints may compel an insurance company to extend coverage to out-of-network facilities.

Insurance companies may consider substituting medical, substance abuse or other mental health benefits for eating disorder treatment. They may also consider substituting the level of treatment coverage is provided for, for example inpatient coverage for outpatient coverage and vice versa.

Keep in mind that an initial denial of coverage is not always final. Initial denials may be overturned at higher levels of appeal after further consultation by specialized doctors with greater understanding of the clinical information. With patient persistence and sufficient support denials may be reversed.

Lastly, many facilities offer support for patients that cannot cover the cost of treatment. Some facilities offer sliding scales or scholarships for patients with little or no insurance coverage. Similarly, payment plans may be negotiated to make payment for treatment more manageable.