Cook Children’s Health Plan Eating Disorder Coverage

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Eating disorders are very serious medical issues that require both physical and psychological treatment to ensure recovery. The Cook Children’s Health Plan is a health maintenance organization that manages benefits for STAR and CHIP members who live within a six-county region of North Texas. If you or your loved one is a member of the Cook Children’s Health Plan and battling an eating disorder, it’s important to begin seeking treatment right away. To discuss treatment options with a trained professional, call us today at .

Using Cook Children’s Health Plan for Eating Disorder Treatment

Eating disorders, including anorexia, bulimia and binge eating, are serious mental and physical illnesses. According to the National Institute of Mental Health, eating disorders affect 2.7 percent of children between the ages of 13 and 18, primarily girls. Using Cook Children’s Health Plan for eating disorder treatment can help ensure adequate care is provided to promote your loved one’s physical and psychological well-being.

The Cook Children’s Health Plan varies slightly between coverage options for Children’s Health Insurance Program and STAR members. STAR is the Texas Medicaid program, while CHIP is for Texas residents up to age 19 who are not eligible for Medicaid. Patients insured by STAR and the Cook Children’s Health Plan are able to receive behavioral health services, including:

• Inpatient treatment
• Outpatient treatment
• Psychiatric support
• Counseling

CHIP members of the Cook Children’s Health Plan can take part in behavioral health services if the following conditions are met:

• Services provided are necessary in the treatment of a mental health disorder
• Services provided are consistent with standard clinical guidelines
• Services provided are not experimental
• Services provided are not merely for convenience rather than medical need

Does Cook Children’s Health Plan Cover Eating Disorders Rehab Programs?

While you are investigating eating disorder treatments for yourself or your loved one, you may wonder whether the Cook Children’s Health Plan covers rehab programs. Both STAR and CHIP members have access to comprehensive health coverage for diagnosed physical and mental illnesses. While the CHIP handbook provided by Cook Children’s specifically notes that coverage includes inpatient and outpatient rehabilitative services for mental health issues, STAR documentation merely states that medically necessary treatments will be provided to and covered for members. This means that if you or a covered child in your life needs to access rehab services, you’ll be able to access them through the Cook Children’s Health Plan.

Inpatient Treatment Length Cook Children’s Health Plan Will Cover

The length of inpatient treatment services can vary greatly depending upon the severity of the eating disorder a patient is facing. Doctors and medical centers that contract with the Cook Children’s Health Plan work with patients to design and provide treatments that are in line with patient’s needs.

Sometimes, however, health insurance can place limits on the length of time a patient’s stay in a facility will be covered. For instance, CHIP members of the Cook Children’s Health Plan have a coverage limitation of 60 days per 12 months within a skilled nursing facility, such as a rehab hospital. The STAR handbook doesn’t note a limitation, but coverage should be verified prior to admission.

Cook Children’s Health Plan Coverage for Eating Disorders With Dual Diagnosis

Like many mental health illnesses, eating disorders are sometimes diagnosed at the same time as or in relation to substance abuse issues. The Cook Children’s Health Plan provides comprehensive coverage for patients with eating disorders who also have a dual diagnosis of alcohol or drug dependency. Your medical team will work with you to ensure that all of your health issues are addressed appropriately. Both STAR and CHIP members have access to inpatient and outpatient treatment within the Cook Children’s system of providers and centers.

Specialty Eating Disorder Treatments Using Cook Children’s Health Plan

As with all other mental illnesses, no two patients will experience the exact same treatment for their eating disorders. According to the National Institute of Mental Health, eating disorder treatments can include or combine the following:

• Medication
• Counseling on nutrition
• Medical monitoring and care
• Psychotherapy on an individual, family or group basis

Each of these areas is covered for both STAR and CHIP members of the Cook Children’s Health Plan, ensuring that the specialty treatment designed for you or your loved one is balanced to meet your needs. However, coverage does not apply to investigative or experimental treatments not yet approved by the government or used commonly in eating disorder treatment protocols.

If you have a question about whether a certain treatment may be necessary or beneficial for you or your family member, make sure to discuss it with your medical team. They can help you to get the information you need to make informed decisions and understand why certain options may not be covered. We can help as well. We have trained professionals available 24/7 to answer your questions and enable you to make the best choices for yourself and your family. Call us at .

How to Cover What Insurance Doesn’t Pay For

When you’ve reached a coverage limitation through your insurance or have chosen a type of treatment that isn’t covered, you may feel anxious about how to pay for these expenses. You may also wonder how to cover routine out-of-pocket expenses that can mount quickly. You have a variety of options to consider if your STAR or CHIP insurance by using Cook Children’s Health Plan for eating disorder treatment leaves you with out-of-pocket expenses or expenses incurred through unapproved treatment protocols.

First, any costs related to approved treatments should be nominal, and these costs are regulated for low-income Medicaid/STAR and CHIP patients by the federal government. Check the national Medicaid cost-sharing page to ensure you have not been inadvertently overcharged. Depending upon your family’s total income versus federal poverty guidelines, your share of the financial responsibility may be even further reduced. Government regulations also mandate that necessary coverage and treatment cannot be withheld because of your inability to pay.

Next, if you are a CHIP member, ensure that you complete your worksheet of all expenses. Once you reach a certain amount of approved out-of-pocket expenses, send this form back to CHIP, and you will receive a new member card that eliminates your copayment for the remainder of the coverage period. STAR members can discuss eligible expenses with Cook Children’s Health Plan representatives to find solutions and mitigate costs.

Finally, coverage by CHIP and STAR insurance is dependent upon meeting low-income guidelines. If you have non-covered but eligible medical costs and continue to meet eligibility guidelines, you may be able to seek assistance through other government agencies and programs open to low-income families.

Verify Insurance Coverage and Find the Best Treatment Programs

Prior to seeking treatment, remember to verify benefits under the STAR or CHIP program as administered by the Cook Children’s Health Plan. Remember that Cook Children’s is the health maintenance organization you’ve chosen to manage your government-provided insurance coverage, and you may need to contact a STAR or CHIP representative for further information.

The Cook Children’s Health Plan enables members to access a wide variety of providers at many different treatment facilities throughout the six-county area the insurer covers in North Texas. When you or a loved one are in need of treatment for an eating disorder, take a bit of time to explore your options. You may need to work through your elected primary care physician for a referral for services, or you can self-refer in emergency situations as allowed by the Cook Children’s Health Plan. For further guidance and to get answers to any questions you may have, call our trained staff at any time. We’re here to help you find the best treatment programs for your eating disorder, and we’re available 24/7 at .