It’s a big decision to seek treatment for your eating disorder. So we know it’s hard to have additional hurdles, like learning insurance jargon so you can interpret your healthcare benefits.
To simplify this process and to make sure you understand the services your insurance will cover, we've created the following tool to guide you through the insurance verification process. It includes everything you will need to have ready for a phone call to your insurance company to get an estimate of the coverage available while you are at The Emily Program.
If you continue to have trouble receiving adequate coverage from your insurance company or if you’re unclear on some of the terminology, please read:
Current Insurance Providers
Note: This list is subject to change. Please use our insurance verification tool and contact your insurance company for coverage details. The Emily Program works with the following insurers, so you receive the highest level of benefits.
Remember to bring your insurance card with you to your appointments.
- BlueCross BlueShield
- Group Health Cooperative (GHC)
- Health Partners
- Medica/United Behavioral Health
- Medical Assistance
- MMSI/Mayo Health Solutions
- America’s PPO
- South Country Health Alliance
- Mutual Health Services
- Anthem BlueCross BlueShield
- Apex Health Solutions
- Medical Mutual
- United Behavioral Health/UnitedHealthcare/Optum
- Beacon Health OptionsValueOptions
- Asuris Northwest Health
- First Choice Health Network
- Premera BlueCross
- Regence BlueShield
- Kaiser Permanente
- United Behavioral Health/United Healthcare/Optum
If The Emily Program is not “in-network” under your insurance policy, you may be able to utilize out-of-network benefits. Not all insurance companies cover all services, so be sure to check with your specific insurance policy about coverage.
If your insurance company is not on the list, there may be other options. Coverage may still be available out-of-network or on a case-by-case basis. Call us at 1-888-EMILY-77 (1-888-364-5977, ext. 1612) to start the process.
Start the journey to recovery now
Use our online form or call 1-888-EMILY-77 (1-888-364-5977) today for information on how to schedule an eating disorder assessment . At The Emily Program, find help. And hope.
Your Welcome/Intake Packet
The Emily Program is nationally recognized for our compassionate and personalized approach to eating disorder awareness, treatment, and lifetime recovery. We’re here to help. For more information about beginning your recovery journey with us, please call 1-888-EMILY-77 (1-888-364-5977, ext. 1612) today.
Preparing for Your First Appointment
Welcome to your first steps toward recovery. If you are looking for Welcome Packet information, it's likely you were directed to this page by our Admissions Team after scheduling your appointment for an intake assessment.
This section includes documents you will need to complete and/or review prior to that appointment. We'll also let you know what to expect the day of your appointment and answer a few common questions.
Print and Complete These Forms
Prior to starting at The Emily Program, we need to learn a little more about you. We also want you to learn about policies and practices related to your care. Click next to your state below to download and print all the forms you will need to complete or review prior to your first appointment.
Ohio: (Ohio intake documents are not yet available online. They will be provided for you to complete and review when you check in for your intake assessment appointment.)
Bring the Following With You To Your First Appointment
1. Completed paperwork (see above)
2. Insurance card (for yourself, your child, or the person responsible for payment, i.e. parent or guardian)
3. Photo ID card (for yourself, your child, or the person responsible for payment, i.e. parent or guardian)
What to Expect at Your First Appointment
Your experience will vary depending on your age (adult or adolescent) and your family dynamic. Below is a general overview of what to expect.
1. Check in at the front desk to submit completed paperwork and take care of any additional documents that may require your attention and/or signature.
2. Next, you will complete a self-assessment that consists of several pen and paper questionnaires related to your relationship with food and body image. The self-assessment is not medical and doesn't require advance preparation. It helps us to get to know you better and develop a customized treatment plan.
3. An intake therapist will review results of the questionnaires and then meet with you to discuss what brought you to The Emily Program and what you hope to gain from treatment. Families are included throughout the adolescent intake process. (There will be a waiting period between completion of your self-assessment and your appointment with the therapist.)
4. At the end of your session with the therapist, you will discuss treatment recommendations and next steps to move forward with care.
Other Useful Information/Tools From The Emily Program
Check our Locations page for maps to prepare for your visit at our outpatient locations or our 24/7 residential care facilities.
Find Out What Services Your Insurance Covers
It's important that you understand the services your insurance will cover. We've created the below tool to help guide you through the insurance verification process. This tool includes everything you will need to have ready for the phone call and every question to ask the insurance representative about your coverage.
Health Insurance Basics
On this page, we try to explain a very complex issue in simple language.
A health insurance policy is a contract between an insurance company and an individual or a group that individuals are part of, like an employer or labor union. Basically, you pay the insurance company a set amount of money during the contract period and, in return, the insurance company agrees to pay for a portion of your medical care. Since your policy is a contract, its terms determine what coverage you may or may not get.
To get the most from your health insurance, it’s important to understand some basic insurance terms and their definitions:
Claim: Paperwork submitted to the insurance company for services covered under your policy. In-network providers usually handle the claims paperwork for you.
Coinsurance: The percentage you pay for services; often the percentage of your responsibility after the deductible has been satisfied. This is usually in lieu of a co-payment, but can sometimes be in addition to a co-payment. This will be determined by the contract you have with the insurance company. For example, you might have to pay 20% of the cost of a surgery, while the insurance company pays the other 80%. You could end up owing very little, or a great deal, depending on how much care you get in a year and whether your policy has an upper limit on coinsurance.
Co-payment (aka co-pays): This is a dollar amount that you must pay “out of pocket” before the health insurer pays for a particular visit or service. For example, your insurer might require a $30 co-payment for each appointment with your Emily Program therapist, while your insurance company pays the rest of the fee for that visit.
Deductible: A fixed dollar amount you pay during the benefit period (usually a year) before the insurer starts to make payments for covered medical services. Plans may have both per individual and family deductibles.
- Some plans may have separate deductibles for specific services. For example, a plan may have a hospitalization deductible per admission.
- Deductibles may differ if you get services from an approved provider or from providers not on the approved list.
It’s easy to get the deductible confused with the co-pay or co-insurance, but they are different things. Let’s say your policy has a $500 deductible per year. If each trip to one of your health care providers costs $250, then you must pay the full amount for the first 2 visits before the insurance company starts paying for your visits.
Coverage limits: Some health insurance policies only pay for health care up to a certain dollar amount (e.g. $500,000 or $1,000,000) for all of your health care or for a specific service. For example, many insurance policies have annual or lifetime coverage maximums. In these cases, the health plan will stop payment when the benefit maximum is reached, and you must pay all the remaining costs.
Exclusions: Your insurance may not pay for every health care service you need. Exclusions are the services which are not covered. Generally, you’re expected to pay the full cost of “excluded” or non-covered services.
Explanation of Benefits (EOB): When you receive a health care service and the claim has been processed, the insurance company will often send you a document explaining how the services were covered and which services were not covered.
In-Network Provider/Contracted Provider: Most health insurance companies “preselect” a list of health care providers who sign a contract with the insurer. Generally, in-network providers agree to accept “discounted” rates for services. The client co-pay and/or coinsurance will be based on this amount. An insurer may also contract with specific providers because their success rate, quality of care, and other factors are good.
Insurance Policy: Another word for the contract you sign with the insurance company. Most health insurance policies are many pages long with a lot of fine print. As a practical matter, few of us need to read all of the fine print. But if you are struggling to get your insurer to pay for certain services—like eating disorders treatment—you will need to know your policy (including the fine print) well. See Advocating for Insurance for more.
Insurance regulation: The individual states have primary responsibility for most health insurance regulation companies and their practices. State legislatures write the laws and a state agency enforces them. Each state has a Commerce or Commissioner who oversees health insurance companies. Federal statutes—such as laws for health care reform and mental health parity (see advocating for insurance)—also govern some insurance practices.
In Minnesota, it's the Commerce Commissioner
In Wisconsin, it's the Commissioner of Insurance
In Washington, it's the Insurance Commissioner
In Ohio, it's the Department of Commerce
In Pennsylvania, it's the Commissioner of Insurance
Out-of-Pocket: This is a term to describe the money you pay from your own funds (that is, out of your pocket) for a health care service, even though you have health insurance. Some common “out-of-pocket” expenses are co-pays, co-insurance, and deductibles. Important: the same insurance policy may have a co-pay for some services and deductible for different services—it all depends on the details of your health insurance policy/contract.
Out-of-Pocket maximums: This is the highest dollar amount that your insurance policy requires you to pay out-of-pocket for covered services in a year. Let’s say your policy’s out-of-pocket maximum is $1,000 a year; once you spend $1,000 out-of-pocket, you may not have to pay anything else out-of-pocket—unless you exceed the coverage limits. Depending on your policy, some costs you pay do not apply to the out-of-pocket maximum. As usual, these issues are determined by your insurance company.
Premium (aka Rate): The amount of money that you or your group (e.g. an employer, labor union, etc.) pays to the insurance company to purchase health coverage. Most premiums are paid monthly. If you have insurance through your employer, the premium is usually deducted from your paycheck.
Prior Authorization: Before agreeing to pay for a certain service or procedure, an insurance company may require you to get permission in advance—prior authorization—for it. Many less expensive, routine services—like a physician’s visit for strep throat—may not require prior authorization. An insurer is more likely to demand prior authorization for more expensive, complex and long-term care—like residential eating disorders treatment.
The insurer usually requires the provider to produce documents and other data to prove that the proposed treatment is “medically necessary.” Some insurers use complex criteria in order to grant a prior authorization and may refuse to reveal the criteria they used to determine if a particular course of treatment can be covered. (Remember though, that a “medically necessary” treatment still won’t be covered if your insurance policy doesn’t include it among the services covered under your benefits.) Since eating disorders treatment can take a long time, The Emily Program often runs into “prior authorization” situations. Fortunately, we have good working relationships with most insurers, and can often agree with them on a course of action.
Advocating For Insurance
Recovery is difficult enough, and we know it’s hard to have additional hurdles, like learning insurance jargon so you can interpret your healthcare benefits.
The good news: you can take steps that will help you and/or your family get what you paid for and deserve from your health insurance provider. And since The Emily Program has good working relationships with most health insurance companies, we can lend a hand.
A good first step is contacting your insurance company to get an estimate of the coverage they will provide while you or your loved one is getting treatment. Use the Insurance Verification Tool to help you. If you have questions or concerns about what you hear, contact us at 1-888-EMILY-77 (1-888-364-5977).
Authorization specialists work on these issues every day, act diligently to help you navigate the insurance system and secure the highest coverage possible. If you do not have insurance, they can help you identify community resources which might be available.
Work With The Insurer
Remember that your request for treatment is reasonable and that you have been paying for insurance so you and your family would be covered in case of a life-threatening illness. Keep in mind that insurance companies are not the enemy, but they don’t always realize how life-threatening eating disorders are.
Your job is to educate the insurance company so it understands the necessity of treatment. It is always easier to get your insurance company to work with you if you approach their representatives in a non-threatening manner. Try to set your emotions aside and always be civil, polite, and determined (not aggressive). Our Insurance Verification Tool can help you communicate with the insurance company.
Many people write two letters to their insurance company. The first one is full of emotion and states what you really think and feel. You “let it all out” in this letter, then tear it up and begin the second letter. This letter is polite and respectful, while still conveying your determination and your unwillingness to give up until you get the care that you or your loved one needs.
Know Your Policy
If you’re running into resistance from your insurer, you’ll need to read your insurance manual and determine what mental health benefits you have. If you have difficulty understanding the document, call the Customer Service number on the back of your insurance card and ask for explanations. Don’t hang up until all of your questions are answered, you understand the answers, and you know the practical consequences of the insurer’s policies and procedures. You must have accurate information as you move forward.
Since treatment at The Emily Program is comprehensive and personalized, be sure you understand which parts of treatment are covered under the “health” section of your plan and which are covered under the “mental health” section. (The Insurance Verification Tool can help you keep track.) For example, your psychiatrist and medical doctor may be paid for through “health benefits” and you should insist that these are billed this way.
You also need to understand the insurance company’s “rules”. Call your insurance company and ask them to explain such things as the appeals process, what criteria they use to determine medically necessary treatment, and who makes those decisions.
Know The Law
When an insurer denies coverage, they may not be clear about the true conditions, standards, and criteria for their decision. That puts you at an unfair disadvantage during any appeals process. Request a copy of the written criteria and also the names and positions of the people making the decisions. Get contact information for the President/CEO of the company and send copies of all letters to him or her.
Remember to carefully document every phone call, including the name of the person you spoke to, date and time, and what was said or decided. Exhaust the appeals process and be very careful when you submit forms; we found that long delays were often caused by insignificant omissions or mistakes such as leaving out a requested number.
Request that the level of care be based on the widely-accepted American Psychological Association guidelines for treating eating disorders. If the request is denied or your insurance company states they use a different set of guidelines, insist that they take full responsibility for the consequences, noting that they are diverging from the guidelines established by qualified experts in the field.
There will be times when you can solve the problem quickly and relatively easily. If you receive a letter denying the requested treatment, call the company. Typically, the person answering the phone cannot reverse the decision, so ask to speak directly to the Medical Director. Ask the Medical Director for a detailed explanation of why the request was denied and what criteria was used to make this decision.
Try to “join” with him or her by stating that you believe an error was made and that it needs to be reversed. Have your documents at your side so you can explain clearly and effectively why you are right. Again, it is very important that you document everything discussed.
If the simple attempt does not work, you will need to file an appeal. Be sure you understand what the company’s appeal process is and follow it completely. Once you have the information you need from the insurance company, start putting together a packet to send to the review committee and the president of the insurance company. Write a letter that is brief, clear and states your expectations and goals concisely and in understandable terms. Include a brief recap of your story and ask for a response within a defined time period.
Your appeals packet should also include documentation, evidence and facts. Insurance companies may deny or limit coverage after mere “paper reviews,” contradicting the judgment and recommendations of the professionals who have examined and treated you or your family member. Ask your treatment team for documentation supporting your request and the rationale for the recommended treatment. It may also be helpful to include research and other scientific evidence.
To find appropriate information, ask your doctor, psychologist or other professional or look at the website of the Academy for Eating Disorders, a professional organization that publishes the latest research findings.
Send all of this information to the insurance company. Be sure to copy it to the president of the company; your state’s Attorney General and Insurance Commissioner; your local state representatives, U.S. Senators, and Members of Congress; advocacy organizations; your attorney and anyone else you think might be interested. If you have an insurance agent or a human relations representative at your company, copy the material to him or her and ask for assistance.
Keep Speaking Up
Too many people around the country must battle with their insurers for months and years (sometimes being forced to file lawsuits) to get the coverage they paid for and deserve.
That’s why our last piece of advice is so important: DON’T GIVE UP. Most insurance companies count on people accepting the denial and not following through with the appeals process. We recently heard that when people follow the entire process, they win in 75% of the cases.
We are sorry that you are in this position and we wish there were easier answers, but we trust that over time and with thousands of people like us fighting, we will change the system. If you are interested in joining the national advocacy movement to end discrimination against people with eating disorders, go to Eating Disorders Coalition for Research, Policy & Action website. EDC works in Washington on legislation that will have a nationwide impact.
In Minnesota, you can join the advocacy efforts of The Emily Program Foundation. Remember, you are not alone in this fight!
Payment For Services
At The Emily Program, we operate in a straightforward, honest, and transparent manner, so you can focus on getting better. That approach extends to working with you to pay for your services. Talk to our staff. We’re here to help. Call 1-888-EMILY-77 (1-888-364-5977) today.
An Overview Of The Payment Process
- You can pay online, in person, or by mail (find the appropriate address below).
- Minnesota, Washington, Pennsylvania, and Cleveland Residential locations:
The Emily Program PC
P.O. Box 856564
Minneapolis, MN 55485-6686
- The Emily Program – Beachwood Outpatient in Ohio
P.O. Box 856804
Minneapolis, MN 55485-6804
- Charges for The Emily Program services are posted at all offices.
- Bring your insurance card with you to every appointment.
- Co-payments are due at the time of service.
- If you are going to miss an appointment, you must cancel 24 hours in advance or you will be billed for the appointment. Please note, insurance companies do not pay for missed visits and late cancellations—this fee is your responsibility.
- We will submit claims to your insurance company for insurance reimbursement.
- You must contact your insurance company to verify coverage for services at The Emily Program. Use this insurance verification tool to help you verify this information.
The Emily Program client accounts team is dedicated to answering any questions about your bill. Call us at (651) 645-5323 or 1-888-EMILY-77 (1-888-364-5977), extension 1357.
If you are experiencing a financial hardship and want to start or continue treatment, please call us at 1-888-EMILY-77 (1-888-364-5977). We’ll do our best to work with you to find a solution.