Insurance Coverage and Eating Disorders
Appeals Process When Insurance Companies Decline Payments
Aug 12, 2009
When the decision to enter treatment has become desirable, the first step is to know what an insurance policy covers and what it does not cover. It won't work, to attempt to appeal a decline in the payment of a service that isn't covered in one's policy. However, a letter to the insurance company's medical overseer from a professional, licensed eating disorder treatment specialist/physician/psychologist, etc., can help to persuade an insurance company to re-evaluate their policies.
If an insurance company will only pay for a small portion of the treatment process or declines payment, the appeals process begins with a letter. Contact the insurance company and find out who would be the appropriate person(s) or department(s) to send the appeal letter to.
Internal Appeals Process
When the insurance company declines payment, request this denial and the reason for it in a letter. Also ask for an explanation as to the insurance company's appeal process.
Saving Letters, Documents and Other Information
Right from the beginning it is pertinent to save letters and documents. Be sure to keep records of phone conversations and the people spoken to, as well as the content of the conversations, times and dates. Yes, it is a lot to remember and do, however, it is important as the appeal process continues and exceedingly important if litigation becomes necessary.
And, just in case losing documents is a talent, keep copies, maybe even more than one copy!
Develop a Filing System
Create a file system. The more organized the better, especially if information is needed in a hurry. Engage the help of a supportive person or persons, especially if organization isn't a strong point. Someone who is gifted with organizational ability would be a most helpful resource.
The appeals process could become a drawn out, lengthy and exhausting enterprise. Access and accept help.
What if the Internal Appeals Process Fails?
The next step would be to communicate with one's state Insurance Commissioner. Please take the time to make copies of this letter and send to the insurance company's head manager (CEO, President). Letters may also be written to:
- The State Attorney General's Office;
- Federal and State representatives; and,
- Agencies that could assist with advocacy.
Another option would be to engage the help of the media. However, this should be well thought out before pursuing. Once information becomes public, there's no foretelling how it will go, or if there could be ramifications. Finally, there will be the loss of privacy. Brain storm this option thoroughly with family, friends and licensed professionals. If possible, perhaps, find someone who pursued this option and discuss what the results were.
Other Options
If the insurance will not pay for the entire cost of treatment, try to obtain an estimate of the total cost of treatment. This can be tricky, since, how the course of treatment will flow is determined by a range of factors, but, it is possible to contact the treatment providers and obtain an estimate.
It might be possible to negotiate payment with a provider. Some providers have a sliding scale fee. It might be possible to obtain state aid, again, depending upon numerous factors. Contact the local Human Services Department. In Maine this branch is known as the Maine Department of Health and Human Resources which includes mental health services/resources.
These ideas may differ depending upon the locality/country of one's residence. However, beginning with the insurance provider is the first step. Do not give up! Remember, eating disorders can be fatal!
Source
NationalEatingDisordersAssociation.org
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