Paying for Eating Disorder Treatment

How Can I Afford Eating Disorder Therapy?

When seeking treatment for an eating disorder, two of the first questions that often arise are:

• “How much will treatment cost?” and
• “How will I pay for treatment?”

The answers to these seemingly simple questions depend on a great many variables. Eating disorders are complex illnesses that present with a number of psychiatric, medical and nutritional issues. Treatment needs will vary based on the severity of these various factors.  Patients often require coordinated care from several healthcare professionals.

Treatment for eating disorders can often be very expensive. Given this reality, it is not surprising that the vast majority of people in the US with eating disorders do not receive any treatment at all. Yet, a better understanding of the options as well as how to advocate for yourself or your family member with an eating disorder can help you access help.

Cost of Different Levels of Treatment

One of the first factors that affect cost is determining what level of care you need. The more intensive the treatment you require, the more expensive it is. For example, being hospitalized in a hospital or medical center is going to be the most costly.  As you progress to less intensive levels of treatment (generally: residential, partial hospitalization, intensive outpatient, outpatient), the cost decreases. Overnight facility stays are the most expensive.  In addition to care from more professionals, the cost includes room and board.

Medical centers have even higher costs because of the nursing and medical specialists involved in care. One inpatient eating disorder program in the US charged an average daily cost of $2,295 in 2015; its partial hospitalization program charged $1,567. A residential program charged on average $30,000 per month in 2010. Consider that many patients may require three or more months of treatment.

Lengths of stay also vary considerably—patients may require from a few days to several months of treatment at different levels. While every patient’s experience is unique, the far greater expense of treatment at the higher levels often results in patients spending relatively less time at the higher levels of treatment and more time at the lower levels. It is an unfortunate state of affairs in the US that many treatments are cut short by insurers that limit stays in the higher levels of care.

Will Insurance Cover My Treatment?

If you are fortunate enough to have health insurance, the next question you have will be whether insurance will cover your treatment. This question has similarly complex answers.

Treatment in medical hospitals or university health centers is usually covered under a patient’s medical health benefits. Typically only short-term stays for medical reasons (unstable heart rate, etc.) are covered.

Mental Health Insurance Coverage for Eating Disorders

Treatment at residential centers and all the lower levels of care is typically provided under a person’s mental health benefits. The first residential eating disorder treatment program opened in 1985. In the 1990s, as managed care started to dramatically shorten hospital stays for eating disorders, other residential centers soon followed to fill the treatment gap.  Patients with eating disorders are increasingly receiving treatment at this level of care, partly in response to changes in federal law.

The Mental Health Parity and Addiction Equity Act was signed into federal legislation in 2008. This law requires insurance companies to provide coverage for mental health and substance use disorders that is equivalent to that for physical health problems. For example, the law requires that insurers do not set behavioral health visit copays higher than medical visit copays at the same level of care. The parity law also impacts treatment limits, mostly eliminating the annual session caps that used to be common among mental health programs.

The Anna Westin Act of 2015, passed by Congress as part of the 21st Century Cures Act in December 2016, further clarified that residential treatment for eating disorders was intended to be covered as part of the parity law.

Getting Insurance to Pay for Treatment: What You Need to Know

You should become familiar with your insurance policy or health benefit plan. Request a copy from your employer or insurance company if you don’t have one. Understand your coverage for the different levels of care. Call your insurance company and ask for a list of facilities and/or outpatient providers who are in-network. In-network providers and facilities are contracted directly with your insurer—they will be the least expensive option. Determine whether you have a large deductible to meet before the insurer starts to contribute to the cost of care and whether after this contribution begins you will have a copay—the portion of the stay or sessions you are expected to pay directly.

You can then call facilities and providers and ask them for your treatment options. If you can find an in-network provider who is contracted with your insurance company, this will always be a cheaper option. However, be aware that many therapists and dietitians who specialize in eating disorders do not accept insurance. Balancing the competing priorities of provider competence and cost of care can be tricky.

Insurance Coverage for Outpatient Therapy

If your outpatient provider will not bill insurance directly, some will provide a superbill that you can submit to your insurance company in order to seek partial reimbursement for the cost of a session.

If you can’t find a facility or provider who accepts your insurance, you can also request a single-case agreement or a network gap exception from your insurer. These allow your insurance company to treat the facility or provider as if they were in-network and pay their fee for your treatment. This is not guaranteed —achieving this can require a lot of advocacy on behalf of yourself or your family members.

Insurance Advocacy

You should be prepared to take on your insurer to advocate for your or your loved one’s care. Sometimes insurance companies will refuse to pay for necessary treatment or will prematurely curtail treatment. It is common for insurers to demand discharge once a patient’s weight or symptoms begin to improve. They may do this without looking at the complete clinical picture—weight restoration and symptom remission are of course only part of the journey towards recovery. In such cases, your providers can appeal on your behalf.  You may even need to sue the insurance company to get them to pay for your treatment. If you or a loved one is struggling to secure treatment for an eating disorder, visit www.DontDenyMe.org to learn about your rights and get connected to resources for filing an appeal and issuing a complaint against your health plan.

Medicare and Medicaid Coverage for Eating Disorders

Regarding publicly-funded programs, throughout the US, there is a shortage of specialized treatment for eating disorders. Medicare and Medicaid providers at all levels of care are often limited. Many plans cover acute medical hospitalization but not lower levels of care.  Few outpatient providers accept public insurance.

Getting Treatment if You Do Not Have Health Insurance

Free and Low-Cost Eating Disorder Treatment

Eating disorder treatment is notoriously expensive. For many patients, this is a huge barrier. However, there are other options:

• University research programs may provide low-cost treatment in exchange for participation in clinical research. You can reach out to major research universities and inquire about research studies.
• Community mental health centers and low-cost counseling centers can provide treatment but may lack providers with specialized training.
• Support groups can also provide support to those who are unable to access treatment. Many treatment centers run support groups for people in their community.
• The Alliance for Eating Disorders has a list of low-cost options including support groups and an interactive treatment finder tool that includes eating disorder treatment options at all levels of care. You can also search for programs that accept Medicare and Medicaid.
• Web-centered, app-centered, and workbook-centered self-help and guided self-help are affordable.
• Treatment scholarships are provided directly by some treatment centers. Project Heal is an organization that provides treatment scholarships to various treatment centers around the country.
• Some group practices, like ours, may have graduate students who can provide therapy for a reduced fee.

Financial barriers to treatment are real. It’s tough enough to be struggling with an eating disorder and having to worry about affording treatment adds another layer of stress and difficulty to the problem. However, doing your research and advocating for yourself or your family member with an eating disorder can help you to get needed help.

Affordable Eating Disorder Therapy in California

Eating Disorder Therapy LA is proud to be able to accept several private and public insurance plans, making outpatient eating disorder therapy more accessible to more people in California. We also offer low fee —$60 therapy spots— with our graduate doctoral externs. Through a collaboration with Project Heal, we are able to provide two scholarship spots for individual therapy. We have a free support group for adults with ARFID.

Reach out to learn more about our affordable eating disorder therapy in California

Sources

Alderman, L. (2010, December 3). Treating Eating Disorders and Paying for It. The New York Times. https://www.nytimes.com/2010/12/04/health/04patient.html

Kazdin, Alan E., Ellen E. Fitzsimmons‐Craft, and Denise E. Wilfley. 2017. “Addressing Critical Gaps in the Treatment of Eating Disorders.” International Journal of Eating Disorders 50 (3): 170–89.

Saffran, K. 2019. “Mental Health Parity Extends to Eating Disorders: It’s Time to Hold Insurers Accountable for Equal Access to Care.” 2019. The Kennedy Forum. February 25, 2019.

Silber, Tomas J., and Adelaide S. Robb. 2002. “Eating Disorders and Health Insurance Understanding and Overcoming Obstacles to Treatment.” Child and Adolescent Psychiatric Clinics of North America 11 (2): 419–28, xii.

Striegel‐Moore, Ruth H., Douglas Leslie, Stephen A. Petrill, Vicki Garvin, and Robert A. Rosenheck. 2000. “One-Year Use and Cost of Inpatient and Outpatient Services among Female and Male Patients with an Eating Disorder: Evidence from a National Database of Health Insurance Claims.” International Journal of Eating Disorders 27 (4): 381–89. https://doi.org/10.1002/(SICI)1098-108X(200005)27:4<381::AID-EAT2>3.0.CO;2-U.