Using EmblemHealth for Bulimia Treatment

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EmblemHealth offers a variety of care management plans for its members, including HMOs, EPOs and PPOs. These plans provide varying amounts of coverage for outpatient and inpatient treatment for conditions relating to mental health and behavioral health, including disorders such as bulimia.

If you are suffering from a disorder such as bulimia or showing the warning signs of the development of a disorder, or know someone who is, you should contact your primary care physician immediately for an assessment. This is the first step in seeking treatment. You can also call our helpline at so we can assist you in beginning the process.

The majority of patients suffering from eating disorders, especially teenagers according to a study published in Psych Central, will work hard to deny that anything is wrong. This is natural, given that one of the main symptoms of an eating disorder is concealed behavior involving habits around food or purging, induced vomiting, or taking laxatives and diuretics. It is essential that a person struggling with this behavior seek an assessment so the process of treatment can begin.

If you have any questions or concerns about how to begin this treatment or how to persuade a loved one you believe is suffering from the disorder to seek care, please call us at , and we can offer assistance and advice. We are here 24/7. Do not put off beginning the process of healing.

Does EmblemHealth Cover Bulimia Nervosa Rehab Programs?

In general, different EmblemHealth plans have different levels of coverage. Mental health or behavioral health issues, such as bulimia nervosa, require previous authorization for treatment at any level beyond routine outpatient care. This includes inpatient treatment, treatment in residential facilities, and non-routine outpatient treatment. According to EmblemHealth’s Member Handbook, non-routine outpatient treatment includes the following procedures, among others:

• Partial hospitalization
• Detoxification
• Outpatient electroconvulsive treatment
• Neuropsychological testing
• Psychological testing

Inpatient services, according to the EmblemHealth Member Handbook, include the following procedures, among others:

• Full hospitalization
• Access to 24/7 skilled nursing care
• Residential treatment
• Surgical treatment

It is essential that you or your loved one seek a qualified medical assessment so your healthcare workers, in consultation with an EmblemHealth representative, can decide the best treatment for your condition.

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

Approval for inpatient treatment for bulimia from EmblemHealth depends on a variety of factors. These factors include present psychological and physical status, patient medical history, response to previous treatment, and recommendations from your team of health care professionals. Inpatient treatment is reserved for more severe cases of bulimia or for those who have not responded well previously to other treatment. Even once a specific period of inpatient treatment has been approved, a series of continual assessments that take into account the patient’s current condition and progress is necessary to extend the treatment.

You should not be concerned if inpatient treatment is not approved for coverage right away. Research has shown that various types of outpatient treatments, including those that involve minimal professional intervention, such as family-based therapy, are statistically as effective or more effective with certain patients suffering from eating disorders than inpatient therapy.

If you have any questions about the differences in coverage or about inpatient and outpatient treatments, do not hesitate to give us a call at .

EmblemHealth Coverage for Bulimia Dual Diagnosis

Among the more serious cases involving bulimia or other eating disorders are those in which there is a dual diagnosis of an eating disorder with other comorbid conditions. Such conditions, recent research has shown, could be among the root causes of eating disorders and may include:

• Alcohol or substance abuse. Between 30 and 37 percent of those suffering from bulimia also have a previous history of alcohol or drug abuse. Substance abuse further weakens the body and makes the consequences of the eating disorder worse.
• Depression. Depression has been reported in 50 to 75 percent of patients with bulimia. The symptoms of depression can exacerbate many of the symptoms of bulimia and quicken the progression of the disease.
• Obsessive-compulsive disorder. Many of the symptoms of obsessive-compulsive disorder are similar to those of eating disorders, including irrational fears, concealed behaviors and social phobia. This dual diagnosis is one of the most common.
• Self-mutilation. This is one of the most serious comorbid conditions with an eating disorder because it involves willful harm to the physical body, including cutting, scratching and pulling out of hair. Many of this disorder’s issues regarding body image and control over emotions are common with most eating disorders.

Because treatment for a dual diagnosis is specialized and often needs to be more extensive than treatment for an eating disorder on its own, inpatient care is often recommended. According to the EmblemHealth treatment guides, such care will likely be fully or partly covered after a full medical assessment and consultation with your health care professionals.

If you have any questions about the options for treatment for a bulimia dual diagnosis, please do not hesitate to call us at so we can assist you. The longer you delay seeking help, the more likely you will need long-term treatment and the higher your risk for serious complications, according to the Mayo Clinic.

Specialty Bulimia Treatment: Treatments Using EmblemHealth

Although treatment in EmblemHealth network facilities or preauthorized treatment in out-of-network facilities is sufficient for many patients to regain control of their lives, some patients require or want specialty treatment from luxury or executive facilities. Such facilities often offer amenities and accommodations not available in more traditional treatment facilities. These amenities may include:

• Private rooms
• Swimming pools or spas
• Gourmet meals
• Equine-assisted therapy
• Yoga classes and therapy

EmblemHealth’s Member Handbook specifically states that any kind of specialized treatment needs authorization after a medical assessment. Although it is unlikely that such treatments will be fully covered by any EmblemHealth insurance plan, some of the procedures and services offered in these facilities, including alternative therapies, may be covered in part or in full after consultation with your team of health care professionals.

How to Cover What Insurance Doesn’t Pay For

After your initial assessment, your health care team, in consultation with insurance representatives, will come up with the best treatment for your condition at an affordable price and with the greatest amount of insurance coverage. But, there may be non-authorized but possibly effective eating disorder treatments that will have to be paid out of pocket.

If you find you are having problems covering the amount that EmblemHealth does not cover, please call us at , and we can assist you with your financial planning as well as on how to find help in treating eating disorder problems. You should not let any of the financial questions stop you from seeking treatment for bulimia, as it will only worsen if not treated.

Verify Insurance Coverage and Find the Best Treatment Programs

We will provide assistance in verifying your insurance coverage and finding the best treatment option for you. Our helpline representatives can educate you about treatments and programs so you are well-informed when you seek treatment. Early treatment of bulimia is crucial because eating disorders can lead to sustained physical and mental health conditions.

If there are issues with obtaining coverage for certain types of treatments with EmblemHealth, please contact your EmblemHealth caseworker, who will become familiar with your situation while handling the process of your treatment. This process cannot get started unless you take the initial step of calling us at or calling your primary care physician or other qualified health care professional to set up a medical assessment.