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Eating Disorders & Reimbursement
Timothy’s Law (aka Mental Health Parity Law) is a NY state law enacted on January 1, 2007, which requires many types of health insurance policies that are issued or delivered in NY to provide certain minimum benefits for mental illness that are comparable to those for physical illness or injury. It provides benefits for (a) biologically based mental illness and for (b) children with serious emotional disturbances (Anorexia, Bulimia, OCD, Major Depression, etc.).
Coverage can be obtained for at least 30 days of in-patient care and for at least 20 days of out-patient care. To be covered for these benefits, you must have either group health insurance or a school blanket health insurance policy.
10 Steps to Getting Treatment and Reimbursement
1) Have a complete assessment
This includes a medical evaluation AND a mental health assessment, to get your ED diagnosis and to determine what level of care is needed (in-patient, out-patient, partial hospital, residential) and what professionals should be included in that treatment.
2) Pursue the recommended level of care
3) Find out about local resources for treatment
Helpful resources are the National Eating Disorders Association (NEDA) information and referral helpline at (800) 931-2237 and the “Referral” area of the NEDA website: www.NationalEatingDisorders.org.
4) Ask your company to “flex the in-patient benefit” if your company doesn’t provide a benefit for the recommended level of care
If you are denied, appeal this directly to the medical director of the company. Eating Disorders are medical illnesses – mention this fact to your insurance company!
5) Document EVERYTHING
You will need to record all of your communications with the insurance company and put your requests in writing if they are denied at first. Be sure to keep copies of everything.
6) Start the appeals process
You will need to file an internal appeal with your insurance company, so first request a letter from them stating their denial of the coverage you are seeking. Also request an explanation of their appeals process so that you can find out the rules – this is important! (Make sure you read the membership book from the insurance or managed care company to ensure that the service you need is clearly included.)
7) Write to the insurance commission and/or speak to an attorney, if a letter to the medical director is unsuccessful
Again, provide copies of ALL documentation.
8) Consider getting the recommended care by arranging for self-pay as you continue to seek reimbursement
9) If the insurance company approves treatment but NOT in a specialized program, appeal this decision or ask the treating clinicians to obtain supervision and training from experts in eating disorders
If this treatment is not successful or beneficial, ask for specialists to provide further treatment.
On the other hand, if you have no insurance, refer to other helpful resources
These include local mental health clinics, departments of psychiatry at medical schools, and even self-help groups for support. You can also apply for state assistance (Medicaid) through your local Department of Social Services or for Medicare if you meet criteria for disability. Some research programs will also provide treatment free of charge if you meet their criteria; research studies are commonly posted on the NEDA website.
10) If all else fails and you are unhappy with your insurance company or insurance commissioner, contact your senators or congressional / house representatives
Search the following government official websites:
If this is unsuccessful, contact your state governor
Most likely, people in your legislator’s office will be able to help you pursue appropriate care for your eating disorder.
For more details on obtaining insurance coverage for treatment of Eating Disorders, please refer to www.NationalEatingDisorders.org. Click on the "Information & Resources" tab at the top of the page and then click on the links "Download the Eating Disorders Survival Guide" and "Download a Document on Insurance Issues" |
