When you or a loved one are struggling with an eating disorder, the last thing you want to do is navigate the convoluted world of health insurance. Unfortunately, confirming coverage is often necessary to get the care you need. The good news is that the landscape of insurance for eating disorder treatment is complex, but manageable—and by understanding it, you can make the process a lot less overwhelming. Let’s break down the main things to know, piece by piece.

Understanding insurance coverage

Eating disorders like anorexia nervosa, bulimia nervosa, binge eating disorder, other specified feeding or eating disorder (OSFED), and avoidant/restrictive food intake disorder (ARFID) require comprehensive, multidisciplinary treatment. This often includes medical care, therapy, nutritional support, and potentially work with other specialists.

Whether this type of care is covered for you or your loved one can vary widely depending on factors such as:

• The type of plan: Commercial insurance, employer-sponsored plans, Medicaid, and Medicare each have different coverage options.
• The insurance product: Many companies offer different insurance products, such as HMO, PPO, EPO, and POS, and even within the same insurance company, coverage typically varies between these products. There may also be several levels of coverage—such as bronze, silver, gold, and platinum tiers—that generally determine how much you’ll be expected to pay out of pocket.
• State and federal laws: The Mental Health Parity and Addiction Equity Act (MHPAEA) requires many insurers to provide mental health coverage—including eating disorder treatment—at the same level as medical coverage. Some states may also have their own laws mandating certain types of coverage.
• Medical necessity: Insurance companies often require a provider to demonstrate that treatment is “medically necessary” for a patient, based on specific criteria.
• The level of care: Coverage and cost of treatment can vary depending on whether treatment is inpatient, residential, partial hospitalization (PHP), intensive outpatient (IOP), or outpatient therapy.

Why it's important to understand your specific insurance plan

Since health insurance plans have different network coverage for eating disorder treatment, it's crucial to review and understand the details of your specific benefits. This can help you avoid headaches down the road, because you can:

• Find in-network providers. Knowing your specific plan and utilizing a provider directory on your insurance company's website will help you identify in-network providers who offer care with a lower out-of-pocket cost. You can also call the number on the back of your insurance card to get direct support from Member services in finding in-network providers.
• Avoid unexpected costs. By understanding your copays, deductibles, co-insurance, and out-of-pocket maximum, you can avoid surprise bills.
• Know your coverage limits. If you know your coverage limits—like the maximum number of visits you can have with a type of provider or if certain types of treatment aren't covered at all—you’ll be able to make informed choices about your care.
• Navigate complex processes. In some cases, you may need to go through an insurance company’s pre-authorization or appeals process. Understanding how that process works and what to expect can help you navigate these steps with confidence.

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Does Medicaid cover eating disorder treatment?

The answer (unfortunately) is, it depends. Because Medicaid is both a state and federally funded program, Medicaid eating disorder treatment coverage varies based on where you live. That means each state has its own standards as far as eligibility requirements for care, what services are covered, the duration of those services, and rates for services.

Additionally, each state designates managed care organizations (MCOs) to deliver covered services to enrollees. You may be required to enroll in an MCO, or this may be voluntary. Either way, if you enroll, you work with the MCO to manage your care, so they can answer all of your questions about eating disorder treatment coverage, including which providers are in network and whether you need prior authorization.

How to check Medicaid benefits

If you have Medicaid, you’re probably familiar with the fact that it has many intricacies. The best way to gain clarity is by contacting your state’s Medicaid agency to understand your specific benefits for eating disorder treatment. Your state government will have a website that provides information specific to your area (select your state here). You can also call the member services number on the back of your Medicaid card to confirm your covered treatment options.

For those who have MediCal (Medicaid in California), the California Healthcare Foundation offers helpful information on understanding that state’s unique programs.

Navigating insurance for eating disorder treatment

Health insurance companies typically provide several resources you can use to determine your coverage for eating disorder treatment and then find a provider or program that is in network.

Contacting your insurance company

The best way to understand what eating disorder treatment coverage you have is to contact your insurance company directly. You can call the member services number on the back of your insurance card, or search for services on your insurance’s online portal.

Depending on your insurer, your mental health benefits may be managed by another company entirely (called a managed behavioral healthcare organization, or MBHO). When you contact your insurance about eating disorder treatment, they’ll be able to tell you if your mental health benefits are managed by an MBHO, and how to get in touch with them if so.

To help you gain clarity on your eating disorder treatment benefits, we recommend asking the following questions:

• Do I have behavioral health benefits?
• If so, are those managed by my plan or by an MBHO? (This helps make sure you’re talking to the right person.)
• Are there any restrictions on covered diagnoses?
• Do I need a referral from my provider or from the health plan to pursue treatment?
• How much can I expect to pay for treatment? (Or ask how much of your deductible you have left to hit this year. This is how much you must pay out of pocket before your insurance will start paying.)
• Do you cover any virtual treatment options?
• Can you help me identify a high-quality, evidence-based eating disorder treatment provider?

Also, if you have a specific type of provider in mind (such as a registered dietitian) or a specific provider or program you'd like to work with, you can ask if that type of service, provider, or program is covered.

Finding in-network providers

Generally, it’s easiest to work with in-network providers because this means lower out-of-pocket costs and less paperwork. There are two ways to find in-network providers:

1. Call your member services number and speak to a representative. Before you make the call, know what type of provider you're looking for or, if you have it, the name(s) of any clinics, programs, or providers you're interested in using.
2. Use the provider search tool on your insurance's website. You typically can search by things such as provider name or speciality, as well as the distance you're willing to travel to see them. The results should clearly identify if a provider is in network or out of network.

Finding out if a specific provider is covered

You may have heard wonderful things about a treatment center or therapist in your area and wonder if they're in network. Most of the time, you need to use your insurance company's provider search tool or call the member services number to figure this out.

Contacting member services has the added bonus of potentially helping you get a rough estimate of your out-of-pocket costs. They can tell you how much deductible you still owe for the year, as well as your coinsurance, which is the percentage of the costs of covered services you'll pay once you hit your deductible (so if you have 30% coinsurance, and a covered service costs $100, you’ll pay $30). Once you know that information, member services can explain your copay for outpatient office visits, inpatient treatment, virtual care, or any other form of eating disorder treatment. However, you should always check these with the provider or clinic.

If you're interested in Equip treatment, you can use our insurance screener to see if we're in-network with your plan.

Prior authorization and coverage limitations

As if deductibles, coinsurance, and finding a quality provider who's in network aren't enough things to think about, sometimes insurance companies require prior authorization or set coverage limitations. But don’t worry, we can break down these elements into understandable pieces, too.

Understanding prior authorization

Prior authorization (sometimes called preauthorization) is when an insurance company requires your medical provider to submit a formal request and receive permission from your insurance company before it will cover the service. Most of the time, this means your chosen healthcare provider (or you) need to submit specific clinical information showing that the care you seek is medically necessary. Even after your healthcare provider submits their paperwork, your insurance company may deny the request. In some instances, they may explain what additional information is needed to approve the request. All of this takes time, which can further delay treatment.

Your best bet for navigating prior authorization is to contact the healthcare provider you wish to see as soon as possible and ask what their prior authorization requirements are. They can tell you what, if any, documents they need from you and also how involved you need to be. You can always contact them as well as your insurance company for updates during this process.

Equip also does our best to make prior authorization easy. Our dedicated utilization management team requests prior authorization directly from insurance companies when required.

Dealing with coverage denials

If your insurance provider denies coverage for eating disorder treatment, they'll send a letter explaining why your prior authorization request was denied. Read this carefully, because it should detail the appeals process. Many times, your insurance will ask for additional documentation to support your request. You may also be able to have your healthcare provider write a letter or call your insurance company directly to advocate for your care.

Extending insurance coverage

In some cases, coverage for treatment ends before a patient has achieved full recovery. This can happen for a variety of different reasons.

Sometimes insurers may completely end coverage, while others may require that a patient steps down to a lower level of care. Unfortunately, research shows stepping down before a patient is ready (particularly if they haven’t reached their target BMI) can increase relapse rates—which is why it’s important to try to stay in the appropriate treatment for as long as you or your loved one needs it. The good news is that payors are often open to extending coverage if they see that it will benefit their members.

If you find yourself in this situation, know that you have options. You can ask your medical provider to explain the need for continued care, or appeal directly to the insurance company, providing clinical justification for extended coverage.

Financial assistance and additional resources

Even if you have insurance benefits, eating disorder treatment can often be expensive—this is for a few reasons, including the fact that it requires a team of specialists and is generally a matter of months (or even years) rather than days or weeks.

But this shouldn't keep anyone from seeking and accessing care. Eating disorders are serious illnesses, and they do not go away on their own. The sooner you or your loved one receive treatment and the more comprehensive that treatment is, the better your outcomes. And if it turns out that your out-of-pocket costs will be more than you can manage, know that there is help available to pay for care.

First, some healthcare providers offer payment plans. For example, Equip offers no-interest payment plans and has financial counselors available to help you navigate those options. Others offer scholarships, often based on the individual's need. Ask your chosen provider if they have similar types of assistance.

Second, some organizations offer financial assistance for eating disorder treatment. These include:

• Project HEAL. Project HEAL provides a one-time grant to individuals who demonstrate that they need financial assistance to access the care they need.
• Moonshadow's Spirit. This organization offers need-based financial aid to those seeking treatment at residential facilities or partial hospitalization programs.

When applying for any type of financial aid, be sure to follow the organization's directions, which typically ask for proof of your financial resources as well as for information about your diagnosis and recommended treatment. If you have any questions while filling out an application, contact the organization directly.

Equip is committed to making treatment accessible

Battling an eating disorder takes a lot of patience and grit—and you may find yourself needing that same resolve while navigating your health insurance plan. Through it all, remember that recovery is possible, and it’s worth fighting for.

At Equip, we firmly believe that everyone struggling with an eating disorder should have access to evidence-based care that works, and that finances shouldn’t be a barrier to treatment. Our goal is to be in-network with as many health plans as possible, and we are focused on making this a reality. Equip is currently in-network with more than 25 health insurance plans plus Medicaid in several states, and we’re constantly working to expand coverage.

Equip's overall mission is to provide access to quality eating disorder treatment for as many Americans as possible, so that anyone living with an eating disorder has access to cost-effective treatment that works.

Navigating insurance with confidence

Insurance can be incredibly confusing, but don't be scared away if you have questions or don't understand something. Whether you have private insurance, an employer-sponsored plan, Medicaid, or Medicare, calling the member services number on the back of your card can be a huge help in learning what eating disorder treatment benefits you have.

Additionally, many healthcare providers, such as Equip, offer financial assistance and have dedicated team members to answer your questions about the cost of care or if your insurance denies a claim. Lean on this support and don't hesitate to advocate for your or your loved one's needs. The sooner they get care, and the more comprehensive that care, the better. If you want to understand your insurance coverage at Equip, you can use our insurance screener or schedule a call with a team member, who will confirm your benefits.

FAQs

Does Medicaid cover eating disorder treatment?

Generally speaking, yes. Medicaid is required to provide mental health coverage that's comparable to the coverage they offer for other medical conditions. Since eating disorders are mental health illnesses, treatment must be covered by Medicaid. However, the exact coverage options vary from state to state.

How can I find out if my insurance covers eating disorder treatment?

The best way to find out if you have eating disorder treatment insurance coverage is to call the member services number on the back of your insurance card and ask about your behavioral health benefits. If you’re interested in Equip treatment, you can use our insurance screener to confirm your coverage.

What is prior authorization, and how does it affect my treatment?

Prior authorization is when an insurance company requires a patient to get approval for care before they can access that service. Most of the time, this means your chosen healthcare provider (or you) need to submit specific clinical information showing that the care you seek is medically necessary. Getting prior authorization takes time, which can delay treatment. And if your insurance provider denies coverage, you need to decide whether to appeal or pay out of pocket.

What can I do if my insurance denies coverage for eating disorder treatment?

If your insurance denies coverage for eating disorder treatment, you can appeal. Check the denial letter, which should explain what additional documentation you need to submit. You may also want to ask your healthcare provider to write a letter to your insurance company explaining why the treatment is medically necessary, or see if they'll talk to the medical director at your insurance company (this is called a peer-to-peer review).

Are there financial assistance programs for eating disorder treatment?

Yes. Two organizations that offer financial assistance for accessing eating disorder treatment are Project HEAL and Moonshadow's Spirit. Additionally, several healthcare providers offer payment plans or scholarships. Equip offers no-interest payment plans.

How can I find in-network providers for eating disorder treatment?

You can find in-network providers for eating disorder treatment by visiting your insurance provider's website. Most have a provider search tool, where you can search by things such as provider name or speciality, as well as distance from where you live. You can also call the member services number on your insurance card to find in-network providers.

Talk to a professional about getting treatment coveredOur team is here to talk you through your options with or without insurance in a free consultation.

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