Allie’s* recovery from an eating disorder started three years ago. Since then, she and her family have paid over $100,000 out of pocket for her treatments. Allie has always had health insurance, but she quickly discovered that her provider’s definition of adequate care was completely out of touch with the reality of her disease. At one point her insurance refused to pay for more than 15 days of partial hospitalization even though her doctors agreed that she actually needed six weeks of inpatient treatment in a residential facility. Not only did her insurance provider fail to help her in times of crisis, but they also skimped on follow up and preventative care, leading to almost immediate relapse when she was forced to leave the hospital before she was healthy enough to do so.
Unfortunately, Allie’s story is far too common. Although eating disorders impact an estimated 30 million Americans, over 60% of whom are girls and women, roughly two thirds of people diagnosed with anorexia nervosa and 94% percent of those with bulimia do not receive treatment. Among those who do get the help they need, many have been forced to leave residential treatment facilities or stop receiving outpatient care before they are ready because their health insurance providers would not cover their full course of treatment. Allie’s friend Erin* has returned to residential treatment five times in the last five years to treat her anorexia nervosa, and each time her insurance ran out before her care team felt she was medically ready to be discharged.
The problem has been so common that the National Eating Disorder Association has an entire section of their website dedicated to “assist people looking for help when accessing care and when insurance denies coverage for treatment of eating disorders.” Not if, but when. Insurers have been known to use a variety of tricks to wiggle their way out of helping their customers pay for life-saving eating disorder treatments that their companies deemed non-essential. Thankfully, the Affordable Care Act is changing that.
Eating disorders are considered a pre-existing condition, which insurers could (and regularly did) use as grounds to deny health insurance before ACA went into effect. Now insurance companies must extend their services to American citizens regardless of their medical history. Thanks to the ACA, Allie and Erin are now guaranteed insurance coverage despite their history of eating disorders.
Both state and private insurers must now include mental health care and substance abuse treatment coverage in all essential benefits packages they provide under mental health parity laws. For Allie, that means her ongoing therapy for her condition is 80% covered. She also has the peace of mind of knowing that if she should ever need intensive treatment again, it would also be covered at 80% by her insurance.
Sadly, though, federal parity laws don’t specify which mental health conditions have to be covered, so insurance companies can still get away with picking and choosing what to provide under this umbrella. Often, eating disorders get cut, even though they are among the deadliest mental health conditions. Some states require all health insurance plans to cover eating disorders as completely as other conditions, and North Carolina does so on a limited basis. In our state laws, the General Assembly names nine approved mental health diagnoses that have to be given the same amount of coverage as “physical illnesses.” The two most well known eating disorders, anorexia nervosa and bulimia, make that short list. Unfortunately, though, many others, including binge-eating disorder and eating disorder not otherwise specified (EDNOS), are left out even though they affect thousands and come with serious health consequences of their own.
The proposed Federal Response to Eliminate Eating Disorders (FREED) Act, co-sponsored by North Carolina’s own Representative David Price, would help address this gap by expanding equitable coverage of treatment to all eating disorders. It would also increase investment in research and public education on the causes, prevention, and treatment of these conditions.
ACA has also extended the length of time children can remain on their parents’ health insurance, allowing them to take advantage of their parents’ benefits until they turn 26. Because eating disorder symptoms often begin in adolescence and early adulthood, this continuity of coverage helps young adults take advantage of the eating disorder treatment benefits available to them. Early intervention at this stage not only offers patients the best chance of recovery, it also keeps health care costs low by avoiding more costly treatments down the line, such as hospitalizations, residential inpatient care, and surgeries or other procedures that may be necessary to treat the effects of severe eating disorders over time. At only 25, Allie is now in recovery and studying social work in graduate school so that she can use her experience to help others. Thanks to her health insurance coverage, she is able to focus on school without the stress of worrying about whether she can afford the ongoing care she needs.
Through these provisions, the Affordable Care Act has already helped make it easier for people with eating disorders to get the care they need. Eighty-five percent of Americans believe eating disorders are serious conditions that should be covered by insurance companies just like any other illness. The passage of the Affordable Care Act and the proposal of bills like the FREED Act demonstrate that policymakers are finally starting to think so, too. To learn more about the FREED Act and find out what you can do make sure our daughters, sisters, mothers, and friends all get access to the care they need, check out the Eating Disorders Coalition website here.
*Some names have been changed upon request.