The answers depend on a great many variables. Eating disorders are complex illnesses that present with a number of psychiatric, medical, and nutritional issues. Treatment needs, and therefore costs, vary based on the severity of these factors. Unfortunately, most people in the United States who have an eating disorder do not receive any treatment at all, often in part because of the potential costs. A better understanding of the options and learning how to advocate for yourself or a family member can help you access help. This article discusses eating disorder treatments and whether insurance covers them. It also explores tips for getting coverage and treatment options without insurance.
Levels of Treatment
One of the first factors affecting the cost is determining what level of care you need. Overnight facility stays are the most expensive. In addition to care from more professionals, the cost includes room and board. Medical centers have even higher costs because of the nursing and medical specialists involved in care. A 2019 report found that a two-week inpatient hospital stay could cost $19,000 or more. A 2020 report on the social and economic cost of eating disorders in the U.S. found that the average cost for intensive treatment in a residential facility was more than $1,200 per day, with an average treatment duration of one month. Lengths of stay also vary considerably—patients may require anywhere from a few days to three or more months of treatment at different levels. A 2017 study found that the average length of stay for treating eating disorders was 37.9 days. While every patient’s experience is unique, the far greater expense of treatment at the higher levels often results in patients spending relatively less time at the higher levels of treatment and more time at the lower levels. It is unfortunate, but many treatments are cut short by insurers that limit stays in the higher levels of care.
Will Insurance Cover Eating Disorder Treatment?
Treatment in medical hospitals or university health centers is usually covered by medical health benefits. However, insurance typically only covers short-term stays for medical reasons (such as an unstable heart rate). Treatment at residential centers and in outpatient programs is typically provided by mental health benefits (which not all policies include). The first residential eating disorder treatment program opened in 1985. In the 1990s, as managed care dramatically shortened hospital stays for eating disorders, other residential centers soon followed to fill the treatment gap. Patients with eating disorders are increasingly receiving treatment at this level of care, partly in response to changes in federal law.
The Mental Health Parity and Addiction Equity Act
The Mental Health Parity and Addiction Equality Act, signed in 2008, is a law that requires insurance companies to provide coverage for mental health and substance use disorders equivalent to that for physical health problems. This applies to most larger group health plans. For example, the law requires that insurers do not set behavioral health visit copays higher than medical visit copays at the same level of care. The parity law also impacts treatment limits, mostly eliminating the annual session caps that used to be common among mental health programs.
The Anna Westin Act
Passed by Congress as part of the 21st Century Cures Act in December 2016, the Anna Westin Act further clarified that residential treatment for eating disorders was intended to be covered as part of the parity law.
Getting Insurance to Pay for Treatment
In order to learn whether eating disorder treatment will be covered by your insurance plan, there are some important steps you need to take. This includes finding out what sort of coverage you have and finding providers who will accept your insurance.
Learn About Your Insurance Plan
Request a copy or your insurance plan from your employer or insurance company. Review your coverage for different levels of care. Call your insurance company and ask for a list of facilities and outpatient providers who are in-network. In-network providers and facilities are contracted directly with your insurer, and they will be the least expensive option. Determine whether you have a large deductible to meet before the insurer starts to contribute to the cost of care and whether after this contribution begins, you will have a copay—the portion of the stay or sessions you are expected to pay directly.
Check With the Treatment Provider
You can then call facilities and providers and ask them for your treatment options. If you can find an-in network provider who is contracted with your insurance company, this will always be a cheaper option. If your outpatient provider will not bill insurance directly, some will provide a superbill, which is an itemized invoice that has the information you need to submit to your insurance company in order to seek partial reimbursement for the cost of a session. If you can’t find a facility or provider that accepts your insurance, you can also request a single-case agreement from your insurer. This allows your insurance company to treat the facility or provider as if they were in-network and pay their fee for your treatment. This is not guaranteed—achieving this can require a lot of advocacy on behalf of yourself or your family member.
Advocate for Treatment
Be prepared to take on your insurer to advocate for care. Sometimes insurance companies will refuse to pay for necessary treatment or will prematurely curtail treatment. It is common for insurers to demand discharge once a patient’s weight begins to improve. They may do this without looking at the complete clinical picture. Weight restoration is only one short leg of the journey towards recovery. In such cases, your providers can appeal on your behalf.
Know Your Rights
You may even need to register a legal complaint against your insurance company to get them to pay for treatment. If you or a loved one is struggling to secure treatment for an eating disorder, visit www.DontDenyMe.org to learn about your rights and get connected to resources for filing an appeal and issuing a complaint against your health plan. Regarding publicly-funded programs throughout the US, there is a shortage of specialized treatment for eating disorders. Medicare and Medicaid providers at all levels of care are often limited.
Getting Treatment Without Health Insurance
Eating disorder treatment is notoriously expensive. For many patients, this is a huge barrier. However, there are other options:
Community mental health centers: Low-cost counseling centers can provide treatment but may lack providers with specialized training. Family-based treatment (FBT): Adolescent eating disorder treatment is sometimes an alternative to more costly residential treatment for teens. In FBT, a lot of the treatment is shifted to parents, who are charged with renourishing their teen and interrupting eating disorder behaviors. Support groups: These provide support to those who are unable to access treatment. The National Eating Disorder Association has a list of low-cost options including support groups. Treatment scholarships: Scholarships are provided directly by some treatment centers. Project Heal is an organization that provides treatment scholarships to various treatment centers around the country. University research programs: You may find low-cost treatment in exchange for participation in clinical research. Reach out to major research universities and inquire about studies. Web-centered: Online, app-centered, and workbook-centered self-help and guided self-help options can be helpful as well.
The Alliance for Eating Disorder Awareness has an interactive treatment finder tool that includes eating disorder treatment options at all levels of care. You can also search for programs that accept Medicare and Medicaid.
A Word from Verywell
Financial barriers to treatment are real. It’s tough enough to be struggling with an eating disorder and having to worry about affording treatment adds another layer of stress and difficulty to the problem. But doing your research and advocating for yourself or your family member with an eating disorder can help you to get needed care.
