Eating Disorder Discrimination

Have you or a family member experienced Eating Disorder Discrimination? Share your story at the bottom of the page.

Eating Disorder Discrimination involves refusal by insurance companies to pay for the costs of eating disorder treatment, including but not limited to  hospitalization; residential, partial hospitalization or day treatment care;  nutrition counseling; psychotherapy; doctor visits; testing or procedures;  medications; psychiatrist visits; group therapy; other recommended treatment. 

Eating Disorder Discrimination also involves delays in approving or paying for  eating disorders treatment; refusing to pay for a full course of treatment and  terminating coverage before a patient is safe to leave treatment; insurance  company harassment of patients or their families, refusal to answer questions  relating to coverage, and denying treatment after it was previously approved.

The reasons behind Eating Disorders Discrimination are numerous, but multiple successful lawsuits around the country and unfortunately, many deaths and the ongoing deterioration of patients waiting for treatment, show that it cannot continue.

The most obvious problem is exclusionary criteria which specifically state  that eating disorder treatment will not be covered. Some states have mental  health “parity” laws, which do not allow some mental illness to be excluded, but in other cases, illnesses such as schizophrenia and others are included while eating disorders are still excluded.

The following excerpt from the Eating Disorders Coalition website explains more: 

Currently the options for eating disorders treatment are highly variable based on where a person lives. A state such as Rhode Island with a comprehensive state parity law requires insurance companies to provide eating disorder treatment so that individuals in that state have options for care. Contrast this with states like Wyoming and Arkansas that have no parity law and no eating disorder treatment available within the state, yet based on national prevalence data, these two states alone likely have over 75,000 individuals with eating disorders within their borders. In the absence of a uniform standard, we believe there is a significant risk that eating disorders will continue to be inadequately covered in many States.

The degree to which Americans enjoy full access to covered services will depend, to a large degree, on the medical necessity standards that plans use to determine whether a service within these categories is covered. Few regulations address the definition of medical necessity: there is no federal definition, and only about one-third of states have any regulatory standards for medical necessity. Consequently, the definition of “medical necessity” is most commonly found in individual insurance contracts that are defined by the insurer. As a result, the standard of medical necessity is most often controlled by the insurer, not the treating professional. This has dire consequences for people suffering from eating disorders who are continually discharged from treatment or denied treatment based on erroneous and shifting definitions of medical necessity, per insurers.

Exclusion of eating disorders is all too common on the part of insurers seeking to limit interventions deemed non-essential. Despite being biologically based mental illnesses with severe physical health complications, including death, eating disorders are all too often found on lists of benefit exclusions.

Have You Experienced Eating Disorder Discrimination?

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