Medical Insurance Coverage is Insufficient for Patients with Eating Disorders
Medical insurance companies have historically provided less coverage to patients with mental illness than those with a physical illness. However, mental illnesses such as eating disorders can be just as deadly. 10-20% of people with anorexia die, making it the deadliest mental illness there is. Eating disorders such as anorexia nervosa, bulimia nervosa, and binge eating disorder affect people of all ages, genders, and races. Today, at least 14 million Americans suffer from diagnosable eating disorders.
Unlike most mood disorders like schizophrenia and depression, eating disorders are frequently denied coverage by health insurance providers. Eating disorders require extensive, long-term treatment because they are such complex issues. In the eyes of the insurance companies, they are vaguely defined, unpredictable, and expensive.
Part of the problem with lack of coverage is the stigma associated with these conditions. There is a sense of personal responsibility attached to a person’s eating habits so it is common for people to think that eating disorders are a personal choice rather than a deep-rooted mental disorder. However, according to the Eating Disorders Coalition, of all the factors that determine who develops an eating disorder, 50- 80% of those factors are genetic.
Major Types of Eating Disorders:
Anorexia Nervosa is an eating disorder characterized by self-starvation and excessive weight loss.
Bulimia Nervosa is an eating disorder characterized by a cycle of bingeing and compensatory behaviors such as self-induced vomiting designed to undo or compensate for the effects of binge eating.
Other eating disorders include Binge Eating Disorder and Eating Disorders Otherwise Not Specified (ED-NOS).
(National Eating Disorder Association, n.d.)
Some physical symptoms of eating disorders include
- Marked weight loss or gain
- Dental erosion
- Heart palpitations
- Rectal prolapse
- Loss of libido
- Hair loss
- Yellowish discoloration of skin
- Memory loss and poor concentration
- Obsessive behavior
- Suicidal ideation
(All Med: Healthcare Management)
Treatment options include:
- Inpatient care: the patient stays in the facility and works with a team of specialists.
- Partial residential: the patient goes home at the end of the day.
- Outpatient: the patient sees therapists but lives independently.
(All Med: Healthcare Management, n.d.)
Patients who are extremely malnourished or underweight (usually with anorexia) are most likely to be admitted to inpatient treatment. Here the patient must undergo the process of restoration to a healthy weight as well as treatment of the psychological issues related to his or her eating disorder to prevent relapse. This requires an integrated process of physical, emotional, and mental healing through the use of medical care and monitoring, medications, psychotherapy, and nutritional counseling. Full completion of this multidisciplinary procedure is crucial for developing a lasting, healthy relationship with food.
Outcome studies following patients for 5 and 10 years after receiving treatment show that approximately 50% of these individuals recover, 25% improve with some residual symptoms, and 25% remain ill or die (Eating Disorders Coaltion, n.d.). Despite this success rate of treatment, only 1 in 10 people with an eating disorder actually receives treatment. Insurance companies are partially to blame for that.
Current State of Coverage
In 2011, the National Institutes of Health spent only $27 million on the study of eating disorders compared to $169 million for autism, and $264 million for schizophrenia. Yet the death rate for anorexia nervosa is double what it is for autism and for schizophrenia (Eating Disorders Coalition).
Insurance companies gauge a patient’s needs based on their Body Mass Index (BMI) which must be lower than 18.5. However, they do not take into consideration the psychiatric needs of patients who may be dealing with major emotional and mental issues that could severely endanger their health.
This restricting diagnosis allows insurance companies to get away with lending out even less-coverage dollars by ignoring the key psychological aspects of this disease. In fact, the majority of insurance providers refuse to cover even the cheapest treatment level: outpatient care.
50% of insurance companies cover only hospital care. Yet, there is a growing and impressive evidence base for cognitive, behavioral, and interpersonal psychotherapy for bulimia nervosa, and binge eating disorder, as well as family based interventions for youth with anorexia nervosa. (Eating Disorders Coaltion, n.d.)
For a patient who requires inpatient care, families without coverage often will pay around $20,000 just to have someone admitted. This is often a financially crippling but necessary action. Just one day of inpatient care runs around $1,700 (Cowell, 2012).
Currently the only option is fighting for coverage on a case-by-case level, however there is no guarantee that their requests will be granted without legislation requiring them to do so. Not to mention, many patients are psychologically impaired from malnourishment, making it difficult for them to barter with the insurance providers themselves.
According to a survey of 109 eating disorder specialists across the United States, representing nearly every inpatient eating disorders program in the country:
- Nearly all specialists (96.7%) believe their patients with anorexia nervosa are put in life threatening situations because of early discharge mandated by health insurance companies refusing to cover treatment.
- 100% believe some of their patients suffer relapses due to limitations of managed care.
- 1 in 5 specialists believe that insurance company policies are indirectly responsible for the death of at least one of their patients.
- 83% report that they have had to reduce the average hospital stay of patients with anorexia nervosa because of managed care requirements.
- Nearly all (98.1%) believe legislation will be necessary to alleviate this situation.
(Eating Disorders Coalition, n.d.)
The government has continued to place eating disorders on the backburner of public health issues despite their urgency. The Obamacare health plan mandates that “any coverage plan offered under the health law’s new statewide insurance exchanges in 2014 must meet federal benchmarks across ten benefit categories, including essential expansions to prescription drug, maternity care, and mental health services.” (Mukerjee, 2012). Unfortunately, Obamacare fails to provide a clear definition of what constitutes a “mental health service”, leaving this part open to the interpretation of insurance companies.
So what kind of legislation should be implemented to alleviate this issue? The FREED Act, proposed in 2009, is the first bill in the history of Congress to address eating disorders research, treatment and education and prevention was proposed. FREED policy assistant, Kathleen MacDonald says. “Many sufferers have become what are referred to as “revolving door patients,” costing the insurance company repeated use of funds, and worse yet, many have lost their lives as a result of lack of care.” (Cowell, 2012).
The FREED Act would amend the Public Health Service Act (1944) to:
“Require a group health plan that provides medical and surgical benefits to also provide coverage for eating disorders. Applies such requirement to coverage offered in the individual market and coverage offered under the Federal Employees Health Benefit Program.”
(Bill Summary & Statistics, 2009-2010)
This act will require any insurer that provides health coverage for physical illness to provide coverage for eating disorders. Also, they will be required to:
- Provide Care according to universally accepted criteria as written in the Practice Guidelines for the Treatment of Patients with Eating Disorders by the American Psychiatric Association.
- The treatment setting must be appropriate to the patient’s needs and clinical presentation. Decisions regarding the treatment setting must include individual variables such as age, sex, ability to manage severity or co morbidity, family involvement, and staff expertise and training.
- All treatment modalities should be covered, including but not limited to family, individual and group therapies, nutrition counseling, psychopharmacology, body Image therapy, and medical treatment.
(Eating Disorders Coalition, n.d.)
It is time to legitimize eating disorders as a national public health concern by providing patients with the proper care and treatment they need. Insurance companies continue to worm through the loopholes of BMI requirements to limit coverage Anorexia nervosa has a 10-20% mortality rate, making it the deadliest mental illness there is and insurance companies are operating under the belief that the treatment of eating disorders is not “cost effective”.
The FREED Act will provide specific guidelines for care and coverage to close up the loopholes that are causing so many patients to be denied help. FREED supports the belief that a human life is always “cost effective” and will ensure that everyone gets fair access to care.
The Eating Disorder Coalition is holding a National Lobby Day on Capitol Hill, April 17, 2013.