Fighting for your right to full insurance coverageby Mark Warren, M.D.
The work that has been done in the fight for equal insurance coverage has been extraordinarily valuable, both to clients at The Emily Program and people with eating disorders throughout the country.
Nearly a decade ago, a federal mental health parity law was passed to ensure people with mental health issues received the insurance coverage they needed for treatment. In 2010, the Affordable Care Act took things another step forward, outlining the Essential Health Benefits that needed to be covered by insurance plans, which included mental health and substance abuse treatment. Then in 2016, more progress came when the 21st Century Cures Act passed, which clarified that the mental health parity law meant to include eating disorder treatment--specifically residential programming—and should not be excluded from insurance coverage.
Despite this progress, the fight is not over. Dr. Jillian Lampert, chief strategy officer at The Emily Program, recently contributed to a story in Bloomberg Law that reported on compliance issues associated with this mental health legislation and what can be done to address noncompliance. Given the vital importance of this topic, I’d like to continue that conversation.
First, it’s crucial for clients to understand that insurance plans should cover eating disorder treatment. As noted previously, legislation is in place that underscores the necessary nature of coverage for mental health, and the federal government has the ability to enforce these policies.
In spite of this legislation, many clients are told their insurance plans don’t cover eating disorders, don’t cover certain levels of care, or are denied coverage for reasons that don’t relate to the severity of their illnesses.
Change is very difficult in all circumstances. But when it comes to change in insurance coverage for medical care, change can be a high mountain to climb. This is certainly true for mental health insurance benefits. Federal law says that policies need to cover mental health. There is still gray area in terms of whether or not that means all mental health diagnoses need to be, and sometimes exclusions show up in policies. That said, because of parity, if your insurance covers care for a condition on the physical health side of your benefits, it needs to cover it on the mental health side. The interconnected nature of the impact of eating disorders on both physical and mental health clearly indicates that eating disorders should be covered.
It’s difficult to get insurance companies to change in practice and there are still some limitations which persist across varies insurance products. Some limitations violate the spirit of the law, but are legal in a technical sense. On top of that, several states have passed their own parity legislation, which may impact how insurance companies understand their obligations.
However, federal law in almost all circumstances should take priority over state law. The bottom line is that if you have insurance, you should have coverage for an eating disorder. Unfortunately, it also means you might have to fight a little bit harder than you’d like to and push your insurance company in ways that might seem difficult.
The ability to have a comprehensive plan is crucial for someone suffering from an eating disorder. Please remember to fight for your right for full insurance coverage. The Emily Program stands ready to help patients and loved ones navigate their insurance company rules and regulations.