By SUSAN KLEIMAN
Published: April 30, 2014
Obtaining adequate insurance coverage for the treatment of eating disorders can be a challenging task for parents and family members. Just when family members are needed the most in terms of working toward recovery, they are often pulled away to fight insurance battles in order to ensure that their loved ones get coverage for the treatment they desperately need. A survey of eating disorder professionals revealed that 97% believed their patients with anorexia nervosa were put in life-threatening situations because their treatment was cut short due to insurance issues. In addition, treatment for eating disorders often requires a multidisciplinary team of specialists, including a primary care doctor, a therapist, a psychiatrist, and a dietitian. Adequate insurance coverage for all these services is often lacking.
Through litigation, appeals, and advocacy, Kantor & Kantor, a California law firm, works tirelessly on behalf of clients whose insurance benefits for eating disorder treatment have been unfairly denied. Lisa Kantor, JD joined the latest AED Tweetchat to discuss her work advocating for insurance coverage on behalf of those suffering from eating disorders. As the only U.S. attorney specializing in insurance litigation for eating disorders, Lisa’s insight and experience continue to be an invaluable asset to the eating disorders field.
Some key points that were raised include:
- Insurance advocacy can take many forms, from documenting communication with insurance companies to pursuing legal action when health benefits are denied.
- Insurance advocacy is everyone’s job – patients, family members, treatment providers, legislators, and community members all play a role in advocating for coverage.
- Patients should request a copy of their insurance policy BEFORE going into treatment and document the name, title, phone number, and email address of all insurance representatives they speak with.
- Under federal law, large group health plans cannot have more restrictive financial requirements or treatment limitations for mental health coverage than for those applied to medical or surgical benefits. This is known as “parity.”
- Providers can help patients maximize insurance coverage by keeping detailed treatment notes tied to American Psychiatric Association (APA) criteria and emphasizing the APA criteria that support the required level of care. Don’t let the insurance company dictate the appropriate level of care! Kantor & Kantor has an APA documentation tool for clinicians that can help organize this information.
- We will add one point to these excellent points and that is appeal, appeal, appeal. Many families will turn away after a “soft” no, but we have found that decisions can be turned around on appeal. Read more here.