Eating Disorders and Health Insurance.

A post or so ago, a friend commented that there “was a lot of help for eating disorders” today. 

Well, sure, if you can pay $40,000 for a residential stay or pay $80 for an intake for an outpatient group.  And if you can’t, then you have to jump through the loops of modern health insurance – the kind that denied a recent client of mine weekly outpatient therapy, despite having a triple diagnosis of Eating Disorder Not Otherwise Specified, Alcohol Dependence, and Major Depressive Disorder, INCLUDING suicidal ideation.

Eating disorders aside, the state of our country’s health insurance is appalling and disgusting.  For some reason, our country has a problem admitting when they are wrong (maybe, just maybe, those dangit-crazy Europeans have got it right!).  For those of you who are satisfied with the way it is, let me explain what insurance reviews are.

Insurance reviews are something mental health providers do regularly.  Insurance reviews grant the client more sessions, barring that they are “sick enough” to require it, but – oh oh oh!  Not too sick that your recommendation of merely outpatient therapy is inappropriate.  In these reviews, the mental health provider, who sees their client on a weekly basis, is often berated and told by a Mass Health representative that has NO clinical training that their clinical judgment is wrong.  You know.  Because therapists are so wishy-washy and all.

I once had an insurance reviewer tell me that a man three weeks out of detox did not require once a week counseling, that he could step down to bi-weekly counseling.  Right.

People often tell me I am too serious, too angry, too WHATEVER about this stuff – but this is the very reason I get angry about it – because today, it is normal for disempowered individuals to be denied the coverage they deserve.  And that is wrong. 

So before all this bullshit “Why can’t Obama save the world even though I’m too scared to vote for healthcare reform!” happened, eating disorders were not recognized as a mental illness for long after others were.  The Federal Mental Health Parity Act was signed in 1996; eating disorders were finally recognized under this act in 2005.  (How victorious it was to receive a letter telling me that.)  And because I went into treatment before this was signed, I ended up footing $1000 worth of three weeks of partial-hospital treatment.  I am lucky I had the resources to pay this; most of the people I’ve seen so far don’t.

Even after the Federal change in 2005, there were separate state parity laws.  Most of these deemed that “biologically-based illnesses”, such as schizophrenia or bipolar disorder, were coverable, but that eating disorders were not; they were very quietly left out of the equation.  In Massachusetts, one of the most progressive states in the union, eating disorders were not signed into the Parity law until July 1, 2009.

So yes, Virginia, there is a lot of treatment for eating disorders.  If you’re sick enough.  But not too sick.  And rich enough.  But not too…no, just rich enough.

6 thoughts on “Eating Disorders and Health Insurance.

  1. The problem seems not just to be that insurance won’t cover, but that many places will not except a wide variety of insurance.

    I’m currently doing research to help somebody find an inpatient program for ED. I would like to be able to go visit them, and that means the location needs to be accessible via public transit since I do not drive. Every single place I have called either does not take insurance at all, or won’t take this person’s insurance.

    I spoke to a really nice person at one place, and I liked what he had to say about the treatment team and philosophy of the way they did things, but there is no way the person I am researching this for could afford to go there since the person would have to pay up front and out-of-pocket. Today, I think I might have found a place that will take the insurance this person has.

    It bothers me a lot, because this person really wants help. I’m sure this person is not the only one who wants or needs help but is unable to get it. It’s particularly a problem here in Massachusetts. (The rest of the USA will have to just wait to find out if Obamacare, which is modeled on the same foolish principle of “if everybody has insurance, insurance companies can decline to cover whatever they want anyway, and still make tons of money on premiums and copays. Why not flush insurance premiums down the toilet? It will serve the same purpose.” or “yeah, I have insurance, but there are no providers willing to take it because the administrative costs are too high to process it” eventually makes its way through.) Further, medical providers can, and often do, choose to accept only certain insurance, presumably, those that pay them the best rate for service and/or have the lowest administrative overhead costs.

    The real problem seems to be that “health insurance” and “health care” have absolutely nothing in common. The former is about profits to the insurance companies, and the latter is about taking care of the health care recipient. Until we get our health care priorities straight in this country, things are not going to get better anytime soon.

    By the way, I have found your blog very inciteful. A lot of it is stuff I have picked up along the way, but just as much, a lot of it is new to me. I have a lot still to learn. ED is not my personal problem, but I do care deeply about this person who struggles with it. You’ve given me some fresh ideas, and I applaud you for your ability and willingness to share of your own struggles.

    1. Glenn,

      I just saw this about a week after you posted it. Thank you so much for stopping by, and you definitely sound like a compassionate, supportive person to your friend who struggles with an ED! I am betting he/she appreciates it 🙂

      I liked the following – “The real problem seems to be that “health insurance” and “health care” have absolutely nothing in common.” Absolutely! PS, you seem to be very well-informed on insurance and its ins and outs also.

      Thank you for the encouragement – I feel that its important to share experience, strength and hope once you’ve reached the other side…of anything in life!

      Take care of yourself,

    2. Also, Glenn, was wondering if you tried Walden Behavioral Care in Waltham, MA? It’s off the commuter rail and a connecting bus, which is a bit of a pain, but they take a range of insurances, including “barebones” MassHealth plans.

  2. As it turns out, Walden is the only place I could find which would take this person’s insurance. I know somebody personally who went there and gave it positive reviews, but the person at the other place which I really liked did not have such good things to say about it. I’m wondering if they were going on outdated information, or if the goal of healthcare is simply becoming “Which institution can profit from it the most?”

    As for your earlier comment, yes, I have become very knowledgeable about the whole health insurance situation in Massachusetts. I saw it as problematic even before it was officially signed into law, and my subsequent experience and independent research about how the law was formed and implemented only added to my utter contempt for the Massachusetts legislature (and Republican governor at the time) who voted for this fully knowing that working class people who can not afford to get insurance would be fined essentially for being poor, and those fines would go directly into the hands of the insurance companies anyway. (Read the law yourself and see how many foxes are watching this hen house. The so-called “oversight board” is loaded with “foxes”.) And I’m not even going to talk about the 400% increase in insurance rates since “mandatory health insurance” went into effect here. Nor am I going to mention that one of the supposed reason for the law’s passage was to curtail such healthcare insurance and healthcare cost increases and to provide for, according to the name of the law itself, accessible, affordable, accountible, quality-driven health care.

    Insurance is a profit driven industry, for which the bet is essentially “Will we take in more in premiums than we will have to pay out for the services provided?” All insurance is this way, but health insurance in particular is devious because the insurance companies get to create all kinds of rules about what they will and will not cover. Because health insurance is a profit-driven industry, there is a lot more incentive to decline to cover any number of health costs. If it costs $50,000 to definitively save a life, and nothing to let a person die, as an insurance company, what is the prime motivation? “Profit or life? Profit or life? Hmmm, let me think for a minute….”

    I don’t agree with Michael Moore’s overall premise of a “single payer system” in Sicko because it essentially leads to the same collection of problems. You still wind up with one very small group of people micromanaging the healthcare that everybody is receiving based upon the cost of that care and the profits which can be made off of it. But he was right about one thing: you shouldn’t have to choose between which of your essential limbs will be repaired at a cost to the insurance company when more than one of them is mangled.

    Sorry, i didn’t mean to get up on a soapbox here, but yeah, I kindof have a lot to say about this topic. I hope you don’t mind my ramblings too much.

    1. Never apologize for a soapbox, especially when it is a well-informed one. I knew a bit about insurance systems, having to vouch for client’s care as a clinician, but you have definitely done your homework and now I know a bit more!

      Seriously, I love it when people make noise. I’ve been criticized for it, so I’m appreciative when others aren’t afraid to speak up over what they feel is wrong/right/meaningful. Thank you…

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