Humana Eating Disorder Coverage

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For most Humana members, behavioral health services are accessed through LifeSynch. LifeSynch provides access to a participating network of behavioral health care providers, coordinates treatment services and acts as a patient advocate. In determining the services and treatment programs to approve during its utilization review, LifeSynch follows the clinical practice guidelines found in The Mihalik Group’s Medical Necessity Manual for Behavioral Health.

Does Humana Cover Eating Disorders Rehab Programs?

In most cases, the answer is yes, at least to some degree. If you or someone you know suffers from anorexia nervosa, bulimia nervosa or another eating disorder, at least part of your treatment will most likely be covered by Humana or its subsidiary, LifeSynch, which is dedicated solely to behavioral and mental health concerns.

For more information about the various eating disorders rehab programs available to you or someone you know, call us at . We are available 24/7 to answer your questions and help you get started on the path toward recovery.

Inpatient Treatment Length Humana Will Cover (28-30, 60, 90+ Day)

The severity of the disorder and the patient’s physical condition determine whether the recommended treatment involves hospitalization, placement in a residential facility or outpatient treatment. The acuteness of the illness combined with psychosocial factors and the presence of additional diagnoses guide the treatment plan, which is developed in consultation with the patient, the patient’s family and a multidisciplinary team of providers, which ideally includes a physician, a psychologist or psychiatrist, a psychopharmacologist for any medication needs, and a rehabilitation nutritionist. As part of the treatment plan, the need for hospitalization or another level of care will be specified.

Eating disorders are treated at the following levels of care:

• Acute short-term inpatient care, or hospitalization
• Partial inpatient care
• Intensive outpatient care
• Outpatient care

Share the proposed treatment plan with Humana, and have your health care provider update the insurance company on your physical condition, the amount of progress achieved and the recommendations of the multidisciplinary provider team. Humana will decide whether to authorize treatment and for how long based on these details.

If you or someone you know would like assistance in locating inpatient eating disorder treatment programs, call us any time at . We can help you find outpatient treatment programs near you as well.

Humana Coverage for Eating Disorders With Dual Diagnosis

People with eating disorders often exhibit other mental health disorders at the same time; these are called co-occurring disorders. When someone has both an eating disorder and another mental illness, the patient is considered to have a dual diagnosis. According to the National Center on Addiction and Substance Abuse at Columbia University, individuals with eating disorders are up to five times as likely to abuse alcohol or illicit drugs. Depression, anxiety disorder and other mood disorders frequently co-occur with eating disorders. People with eating disorders also commonly suffer from obsessive-compulsive disorder.

For dual diagnosis patients, it is important to identify and treat all health-related conditions. If you or someone you know is dually diagnosed, seek out treatment options that are able to address the multiple conditions.

LifeSynch or Humana usually covers treatment for both eating disorders and co-occurring mental illnesses. If you have been dually diagnosed, consult with your insurance plan representative and share your proposed treatment plan in advance to maximize the benefits you receive.

If you need help finding outpatient programs or residential facilities that specialize in dual diagnosis anorexia treatment care, please call us at .

Specialty Eating Disorder Treatments Using Humana

Though securing coverage for nontraditional treatments presents more barriers than obtaining coverage for conventional treatment programs, Humana may cover specialty anorexia treatments in some cases. If you and your provider demonstrate the medical necessity of the treatment, Humana might approve the program or approve partial coverage for it. Approval of a specialty treatment program requires that the requested services be the most appropriate available and that they follow generally accepted medical standards. Treatments with clinical research evidence that supports their use are more likely to be covered than those without any supporting research evidence.

Other specialty programs, such as luxury and executive treatment centers that offer additional amenities at greater expense or treatment facilities exclusively for followers of a certain faith, likely will not be covered by Humana or any other insurance company.

How to Cover What Insurance Doesn’t Pay For

Treatment of an eating disorder is usually costly, since effective treatment requires an integrated, multidisciplinary approach to care that involves a team of providers and specialists who must provide comprehensive medical, mental health and nutritional services. When estimating the cost of treatment, you must factor in the location, the level of care, whether you will be in an inpatient or outpatient setting, the duration of treatment, the amount of follow-up care you will receive, and whether you have other conditions that also require treatment.

Medical benefits coverage might be detailed separately from mental and behavioral health services. Be sure that all benefits available through your policy have been fully exhausted. Also, use all available appeal options if your coverage is denied by your insurance company. Frequently, review by an insurance analyst at a different level in the company produces a different ruling.

Since eating disorders are potentially life-threatening, it is critical to begin treatment immediately, regardless of cost. All options for procuring financial sources must be explored, including financing options available from the treatment center.

Verify Insurance Coverage and Find the Best Treatment Programs

Whenever possible, verify insurance coverage and authorization requirements prior to beginning treatment in order to minimize the chance that claims will be denied. First, carefully read any insurance policy documents to become familiar with terminology, covered services and coverage limitations. Follow this up by speaking with insurance plan representatives, employee benefits staff, medical claims personnel, and other relevant, knowledgeable persons to verify details and get any further clarification or explanation you need. Document these conversations and any other discussions relating to coverage or the treatment plan. These notes can remind you of details you might otherwise not remember, and they can aid in any appeals you might need to make for denial of claims. To know more about the benefits of using Humana insurance for eating disorder treatment, call us today.

In addition to verifying insurance coverage, verify the processes required by Humana for obtaining authorizations for treatment. If you follow the proscribed process, you will minimize the likelihood that payments for services will be delayed or denied.

Armed with information about the coverage limits and potential out-of-pocket expenses, you will be better prepared to search for the treatment program best suited to your particular combination of benefits coverage, budget and treatment plan. When selecting a suitable eating disorder treatment program, consider how close the facility is to family or other support as well as its location in relation to transportation options, its treatment philosophy and its ability to address dual diagnoses if applicable.

For help finding the best eating disorder treatment program for you or someone you know, please call us today at . We’re available 24/7 to help.