Denver-based behavioral hospital offers tools to make insurance providers a partner on the path to recovery
Denver, CO (October 12, 2009) –
Eating disorders became one of the many mental illnesses now due the same benefits as medical and surgical treatments, as the U.S. Wellstone/Domenici Mental Health Parity and Addiction Equity Act of 2008 took effect on Saturday, October 3, 2009. Eating Recovery Center, a behavioral hospital providing comprehensive and sustainable treatment of eating disorders, offers individuals seeking treatment advice to maximize their access to benefits – whether they’ve had these benefits all along or are newly covered.
“Your medical insurance provider can be a valuable partner in your path to eating disorder recovery. The key to building this partnership lays in doing your homework before you enter treatment,” explains Dr. Kenneth L. Weiner, founding partner and medical director of Eating Recovery Center, who was instrumental in passing Colorado’s parity law. “This means gaining a thorough understanding of your insurance plan and choosing a facility and course of treatment that best align with your benefit structure.”
The U.S. Parity Act, which became law on October 3, 2008, requires those group health plans with 50 or more employees who choose to provide mental health benefits to provide the same coverage as medical and surgical benefits. According to Eating Recovery Center, an eating disorder center in Denver, understanding these new insurance benefits boils down to asking a few simple questions, including the following.
- Does the insurance company cover mental health treatment?
- Does the plan have different benefits for inpatient versus outpatient courses of treatment?
- Are there limitations on the number of days a patient can stay in treatment or the level of care he or she can receive?
- What are the plan’s deductibles, co-pays and expected out-of-pocket costs?
- Will the plan waive limitations on mental health treatment for serious mental illness, biologically based illness or parity diagnosis? Many plans will waive limitations for serious mental illnesses such as eating disorders.
Once an individual seeking treatment has gained a thorough understanding of their benefits, exploring treatment options is the next important step.
“Before choosing a treatment facility and determining a course of treatment, it’s important to see how several elements, including length of stay and level of care, will match up with your benefits structure,” explains Weiner. “It’s also important to understand if the treatment provider is an in-network or out-of-network provider, or if they will work with your insurance plan to contract a single case agreement.”
Eating Recovery Center explains the distinction among the three different types of providers.
- In-network providers: These facilities are in an insurance company’s network of service providers and will be subject to in-network insurance benefits. It’s important to compare the course of eating disorder treatment an in-network treatment team recommends with the insurance plan benefit structure to determine the best plan for the patient.
- Out-of-network providers: Typically, an out-of-network provider is subject to more insurance limitations and less coverage. Though portions of an out-of-network provider’s service may still be covered as described in an insurance plan, it’s important to note that this type of provider can balance bill a patient for any treatment the insurance company does not cover. Eating Recovery Center recommends working with an out-of-network provider to determine total expected out-of-pocket expenses prior to entering treatment.
- Single-case agreements: A single case agreement is a contract between an individual patient's insurance company and treatment provider, which allows that patient to be treated as though he or she has in-network benefits. Insurance providers who offer single-case contracts will review potential agreements on a by-patient basis. Oftentimes, the treatment facility will facilitate this process on the patient’s behalf. Before entering treatment, patients should ask the center if this is something they are willing and able to do. It’s important to note that the agreement is specific to the current episode of care and does not apply to care outside of this treatment episode.
“By doing this important research, you’ll minimize stress, avoid the unexpected, and maintain an upfront understanding of your treatment throughout the recovery process,” explains Weiner.
About Eating Recovery Center
Eating Recovery Center, situated at the foot of the Rockies in beautiful downtown Denver, Colorado, provides individuals 17 and older sustainable treatment for eating disorders in a warm, nurturing environment. Our comprehensive program offers patients from across the country a continuum of care that includes inpatient, residential, partial hospitalization, intensive outpatient and outpatient services in a behavioral hospital setting. Our compassionate team of professionals collaborates with treating professionals and loved ones to cultivate lasting behavioral change. For more information please call 877-825-8584 or visit www.eatingrecoverycenter.com.