Using APS Healthcare for Anorexia Treatment

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Does APS Healthcare Cover Anorexia Nervosa Rehab Programs?

If you or someone you know suffers from anorexia nervosa, treatment is most likely covered by APS Healthcare. APS Healthcare provides benefits for diagnoses listed in the Diagnostic and Statistical Manual of Mental Disorders. Major eating disorders are classified as anorexia nervosa, bulimia nervosa and eating disorders not otherwise specified.

If patients show symptoms of sufficient severity to meet the criteria for the requested level of care, then APS Healthcare will at least partially cover the eating disorder treatment. In addition to assessing a patient’s clinical history and symptoms, APS Healthcare staff reviews:

• Age
• Comorbidities
• Complications
• Progress of treatment
• Psychosocial situation
• Home environment

The decision to approve treatment is made by a care manager when a requested service meets specified criteria in all these areas. If APS Healthcare denies a requested service, then the patient and the patient’s family have the right to appeal the decision.

Inpatient Treatment Length APS Healthcare Will Cover

APS Healthcare’s clinical practice guidelines follow the American Psychiatric Association guidelines in determining the level of care required. The decision to be treated while living in a residential facility or on an outpatient basis depends on the severity of the disorder and the treatment plan developed in consultation with the patient, family members and a multidisciplinary team of providers, which should include a physician, psychologist, psychopharmacologist and nutritionist.

The patient’s weight and physical condition determine the acuteness of the disorder. The level of severity combined with psychosocial factors and the presence of additional diagnoses guide the treatment plan. These same factors determine the need for hospitalization or another level of care, which APS Healthcare recognizes, in order of intensity from greatest to least, as:

• Acute inpatient
• Residential treatment
• Partial hospital
• 24-hour observation
• Intensive outpatient
• Outpatient

How long you are allowed to stay at an inpatient treatment center depends on your physical condition, the amount of progress achieved and the course of action agreed to in the treatment plan. The amount of that stay that will be covered by APS Healthcare depends on whether the care manager reviewing the claims and treatment authorization agrees that the services are medically necessary and the most appropriate options available.

If you or someone you know would like assistance in locating inpatient anorexia treatment programs, call us any time at .

APS Healthcare Coverage for Anorexia Dual Diagnosis

People with eating disorders often exhibit other mental health disorders, called co-occurring disorders, and the combination of these disorders is known as dual diagnosis. For example, up to half of the individuals suffering from eating disorders also suffer from clinical depression.

According to the National Center on Addiction and Substance Abuse at Columbia University, individuals with eating disorders such as anorexia are up to five times as likely to abuse alcohol or illicit drugs, and up to half of all eating disorder patients have a substance abuse problem. To facilitate a successful treatment strategy, the symptoms of each co-occurring disorder must be identified and understood.

APS Healthcare coverage includes treatment for both anorexia and the other mental illness. If you or someone you know has received a dual diagnosis, consult with your insurance plan representative and share your proposed treatment plan in advance to maximize the benefits you receive.

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

Specialty Anorexia Treatment Treatments Using APS Healthcare

Though securing coverage for nontraditional treatments presents more barriers than for conventional treatment programs, it is possible to use APS Healthcare for specialty anorexia treatments in many cases. APS Healthcare understands the need for individualized treatment. Therefore, APS Healthcare considers requests for approval if the patient and health care provider demonstrate the medical necessity of the treatment. Approval of a specialty treatment program also 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 typically are more convincing 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 insurance.

How to Cover What Insurance Doesn’t Pay For

Effective treatment of eating disorders requires an integrated approach to care that involves medical treatment as well as mental health treatment, therapy and nutritional rehabilitation. Such comprehensive care involves a multidisciplinary team of providers and specialists. Consequently, treatment of an eating disorder usually is more costly than either medical or psychological treatment alone. The cost of treatment depends on multiple factors, including the location of services, the level of care required, whether treatment is received in an inpatient or outpatient setting, and the duration of treatment. Additionally, follow-up care is usually required after the initial treatment.

Ideally, insurance coverage would pay the entire bill for both outpatient and inpatient services. In reality though, even the best insurance plan will require the patient to pay for part of the costs.

If you believe treatment is necessary but your insurance will not pay, then you should appeal. Often, further review by an insurance analyst at another level yields more favorable results. Exhaust all appeal options available. Then, assess the costs that remain to be paid.

Since anorexia nervosa is potentially life-threatening, immediate treatment is vital. According to the National Eating Disorders Association:

• Anorexia nervosa has one of the highest premature death rates of any mental illness.
• Between 5 and 20 percent of individuals with anorexia nervosa will die from the condition.
• Medical complications from anorexia cause serious physical problems such as organ damage, osteoporosis and cardiac arrest.
• Early treatment expedites recovery; some studies have shown that treatment within five years has an 80 percent success rate while treatment delayed for 15 years only has a 20 percent rate of recovery

Even if insurance will not cover all costs, treatment for you or someone you know should not be delayed. All options for procuring financial sources must be explored, including financing options available from the treatment center. If you or someone you know is seeking suggestions for possible sources of payment or want to know more about the benefits of using APS Healthcare for eating disorder treatment, call us at at any time. We are here to help you.

Verify Insurance Coverage and Find the Best Treatment Programs

Before treatment begins, insurance coverage must be verified. First, read the insurance policy carefully, and ask an insurance plan representative for clarification or further explanation. Note that medical benefits coverage might be detailed separately from mental and behavioral health services. Learn what authorizations for treatment the health insurance company requires so that the likelihood of denial of claims and delayed payments is minimized.

Once insurance coverage is verified and you and your family know the coverage limits and possible out-of-pocket costs, the search for the treatment program best suited to your coverage, ability to pay in the absence of insurance, and medical and psychiatric needs begins. Additional considerations when selecting a suitable anorexia treatment program include location, treatment philosophy and the availability of resources to address other mental health conditions.

If you’re finding help in treating eating disorder for you or someone you know, please call us today at . We’re available 24/7 to help you.