woman writing at desk

Welcome Packet

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.

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.

Minnesota

Adult Forms

Adolescent Forms

Adult Telehealth Forms

Adolescent Telehealth Forms

Ohio

Adult Forms

Adolescent Forms

Adult Telehealth Forms

Adolescent Telehealth Forms

Pennsylvania

Adult Form

Adolescent Forms

Adult Telehealth Forms

Adolescent Telehealth Forms

Washington

Adult Form

Adolescent Forms

Adult Telehealth Forms

Adolescent Telehealth Forms


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

Find us

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.

Read more

Health Insurance FAQs

Health Insurance FAQs

What does ‘covered service’ mean?

If a service is ‘covered’ by your insurance that means it is included in your benefits. Those benefits also determine the portion of out-of-pocket cost associated with the service.

What does it mean if something is excluded from my insurance plan?

If a service is excluded, it is not included in your benefits. You may choose to pursue that service and pay for it yourself.

Why aren’t my benefits a guarantee of payment?

  • Insurance companies will tell you: “Benefit quotes are not a guarantee of payment. Payment is determined at the time a claim is received.”
  • The Emily Program checks coverage for all of our services against your benefits as accurately as possible; however, many client-specific variables will impact your benefits once a claim is sent. These variables include: Diagnosis code, length and frequency of visits, service location and treating provider.

Why can’t The Emily Program tell me exactly how much my treatment will cost?

The total cost of treatment is determined by your benefits at the time services were provided. This includes network status, out-of-pocket payments made year-to-date, insurance pricing for these services, and The Emily Program’s contract with each insurance company. These factors (among many others) affect how a claim is processed and paid by insurance – and with this many variables, it isn’t possible to provide estimated total out-of-pocket costs with accuracy.

What does it mean when a service requires authorization?

Insurance may require additional permissions (authorizations) be obtained by The Emily Program before services can be provided. Authorizations for service generally are obtained by The Emily Program prior to the service being rendered.

  • While the authorization must be approved for the service to be covered, an authorization does not guarantee coverage for a service. If you want to know for certain whether a service is covered, you must talk with your insurance provider.
  • Insurance payment is determined at the time a claim is received and decisions are based off medical necessity.

What is “Coordination of Benefits” and what do I need to do?

“Coordination of Benefits” is an annual requirement for all insurance companies to determine if additional insurance coverage exists. If dual insurance coverage does exist, Coordination of Benefits will determine which plan is primary, and which plan is secondary. If Coordination of Benefits is needed on your plan, all services billed will be denied and you will be responsible for 100% of the amount owed.

  • Call your insurer and inform them if you have additional coverage (e.g. a secondary insurance company.)

What’s the difference between primary and secondary insurance?

When dual-insurance coverage exists, one of the plans identifies as primary, i.e. the ‘first in line’ to pay for your healthcare services. The other will identify as secondary. Services are billed to both insurance plans prior to deductible or co-insurance costs being billed to the client. Call your insurance provider to have Coordination of Benefits set up with both plans prior to claims being processed through insurance (see above).

Can my services be billed differently to accommodate a better benefit level?

The Emily Program submits claims to insurance based on the service rendered, the amount of time for each service, the medical information required (i.e. diagnosis code), and the contract we have with the insurance company. Claims cannot be adjusted to accommodate your benefits.

  • Patient responsibility amounts are determined by your insurance company, not The Emily Program.

For additional questions and information regarding your benefits, please contact the Customer Service Line on the back of your insurance card.

Please call The Emily Program Client Accounts Team with questions regarding the services you have received, clarification on your statement and payment plan options: 1-888-364-5977, ext. 1357.

Read more

Advocating for Insurance

How to advocate for insurance you deserve

Educating your 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 policy 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.

Ask for a case manager if you’re not getting the information you need.

Since treatment at The Emily Program is comprehensive and personalized, be sure you understand which parts of treatment are covered under the medical benefits section of your plan and which are covered under the mental and/or behavioral health section. (The Insurance Verification Tool can help you keep track.)

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 them.

Appeal effectively

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. Follow your insurer’s process and be very careful when you submit forms. We find that long delays are often caused by insignificant omissions or mistakes such as leaving out a requested number.

Request that the level of care decision 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 them 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 WithAll. Remember, you are not alone in this fight!

Read more

Insurance Terms and Definitions

Insurance terms and definitions

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 of individuals, 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 your policy’s upper limit on coinsurance (called an “out of pocket maximum”).

Co-payment (aka co-pays): The dollar amount 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. Co-pays are due at the time of service and may not contribute to the overall out-of-pocket maximum.

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 in-network provider or out-of-network provider.

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 future 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 that 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 claims for services were processed and any services that were not covered.

In-Network Provider/Contracted Provider: Most health insurance companies contract with 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 of their success rate, quality of care, and/or other factors.

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 How To Advocate for Insurance for more.

Insurance regulation: The individual states have primary responsibility for most health insurance 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.

Out-of-Network Coverage: If your insurance company is not contracted with a health care provider, you will typically pay a higher out-of-pocket cost for services.

Out-of-Pocket: 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: The highest dollar amount your insurance policy requires you to pay out-of-pocket for covered services in a year. Let’s say your policy’s in-network 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 or receive care at an out-of-network provider. 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.

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 require 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 may run into authorization challenges. Fortunately, we have good working relationships with most insurers, and can often agree with them on a course of action.

Read more

What Will Your Insurance Pay?

What will your insurance pay?

Step one: Call your insurance provider

You and your loved ones are the best advocates for your own benefits. The Emily Program will contact your insurance company for a general quote of benefits after scheduling your intake appointment, but to determine how much of the cost of your care you are responsible for, you must contact your insurance provider personally.

Our insurance verification tool will help guide you through this conversation. This tool includes everything you will need to have ready for the phone call to your insurance company to get an estimate of your insurance benefits 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 the terminology, please read our:

If you are unable to get the information you need, another option is to call your insurance company’s ‘Health Advocate’ or ‘Case Manager’ department. These insurance representatives are dedicated to helping you understand and navigate your benefits. (Look for a phone number or other contact information on the back of your insurance card.)

Read more

Current Insurance Providers

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.


Minnesota

  • America’s PPO
  • BlueCross BlueShield
  • Group Health Cooperative (GHC)
  • Health Partners
  • Humana/LifeSynch
  • Medica/United Behavioral Health/Optum
  • Medical Assistance
  • Medicare
  • MMSI/Mayo Health Solutions
  • PreferredOne
  • SelectCare
  • South Country Health Alliance
  • UCare

Ohio

  • Aetna
  • Anthem BlueCross BlueShield
  • Apex Health Solutions
  • AultCare
  • Beacon Health Options
  • CareSource
  • Cigna
  • Humana/LifeSynch
  • Medical Mutual of Ohio
  • Mutual Health Services
  • SummaCare
  • UnitedHealthcare/Optum

Pennsylvania

  • Highmark
  • UPMC

Washington

  • Aetna
  • Amerigroup
  • Asuris Northwest Health
  • Cigna
  • Community Health Plan of Washington
  • Coordinated Care*
  • First Choice Health Network
  • GAIP
  • Kaiser Permanente
  • Molina Healthcare
  • Premera BlueCross
  • Regence BlueShield
  • United Behavioral Health/United Healthcare/Optum
  • UHC Community Plan*

*In-network coverage in King County


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 1-888-364-5977, ext. 1612 to start the process.

Read more

The Emily Program Logo