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Does WellPoint Cover Treatment for Eating Disorders?

ED 05Eating disorders are a serious problem in the United States. According to the National Eating Disorders Association (NEDA), eating disorders have the highest morality rate of any psychiatric disorder. Before healthcare reform most insurance companies little or no coverage at all for eating disorder treatment. The healthcare reform law now requires that insurance companies cover treatment for eating disorders. Although it's mandated, there are still coverage limits you should be aware of before relying on your coverage.

WellPoint Insurance for Eating Disorder Rehab(s)

WellPoint will pay benefits for several types of rehab treatment, including;

  • Outpatient treatment
  • Inpatient treatment
  • Treatment therapy
  • Aftercare treatment programs

How Much of the Cost of Treatment Is Covered by WellPoint?

Healthcare reform requires insurance companies like WellPoint to cover eating disorder treatment the same as any other medical event. In general, the richer your insurance coverage is, the richer your coverage will be for eating disorder rehab. Your eating disorder benefits are directly related to the other benefits offered by your policy.

Can I Pay Above What My Insurance Will Provide to Receive Treatment?

Absolutely. While your coverage may not be limited to a specific dollar amount, the number of days WellPoint will pay for treatment may be. If you have exhausted the benefit offered by WellPoint for eating disorder treatment, you can pay above and beyond what WellPoint has paid to continue your treatment program.

Outpatient Disorder Treatment vs. Inpatient Disorder Treatment

Outpatient and inpatient treatment centers have similar focuses. However, they are setup differently.

  • Outpatient treatment centers allow patients flexibility to continue the daily activities of normal life. Treatment takes place periodically during certain hours of the day/week.
  • Inpatient treatment centers treat their patients for 24 hours per day. The patient sleeps, eats and lives in the treatment center. There are limited opportunities to revert to old eating habits while in treatment. The environment at the treatment centers provides a stable medical, nutritional and mental safe haven.

Should I Choose a Residential Treatment Center?

"The healthcare reform law now requires that insurance companies cover treatment for eating disorders." Residential treatment centers provide an intense recovery environment. Most residential programs use medical doctors, nutritional specialists and therapists as part of their treatment program. Because of the amount of time patients spend in a residential treatment facility and the amount of resources put into your recovery, they are more expensive than outpatient treatment. Cost is something you should consider. Residential programs aren't always the best option. They temporarily remove the patient from the environment they will eventually return to and be expected to succeed in. This type of treatment can have negative repercussions when the patient returns to daily life. Your doctor, therapist or nutritionist should act as a resource in determining the type of treatment program that fits your situation best.

Will WellPoint Pay for Out-of-State Treatment?

WellPoint offers health insurance policies in many states. Depending on the state in which you live, you may have more than one provider network option.

  • If your plan requires you to seek medical care within WellPoint's limited network of providers, you will have to pay the full cost of any treatment you receive outside of your home state.
  • If the network you choose offers access to a nationwide network, you may be able to receive benefits for using an out-of-state treatment center.
  • If your plan uses a local provider network, but also offers out-of-network benefits, you should be able to receive benefits for out-of-state treatment centers, but you'll likely pay more than if you use an in-network facility.

Does WellPoint Pay Benefits for Luxury or Private Treatment?

Because luxury and private treatment aren't considered medically necessary in order for most people to recover, most insurance companies do not cover them. This is the case for WellPoint. While standard treatment is covered, luxury rehab and private treatments are not.

What Does Executive Treatment Offer Over Other Rehabs?

Executive treatment centers cater to business professionals, celebrities and other professionals that need to conduct business while receiving treatment. Patients in an executive treatment center will have access to a phone and computer, whether it is in their room or a community business office.

What Treatment Lengths Will WellPoint Pay For?

Standard treatment lengths for eating disorder treatment programs are;

  • 30 days
  • 60 days
  • 90 days
  • 180 days
  • 270 days
  • 365 days

While WellPoint does not use standard daily limits when determining what length of treatment they'll pay for, they do consult with your doctor, therapist or nutritionist. The goal is to agree on the amount of treatment that is medically necessary. Once the treatment length is pre-certified through WellPoint, you can rest assured it will be covered.

What If I Don't Have Health Insurance?

If you find yourself in a situation in which you need help for an eating disorder and you don't have health insurance, here are some options you explore;

  • Overeaters Anonymous (OA) and other local eating disorder support groups
  • State or city-sponsored treatment programs
  • Using a credit line to pay for treatment

Something to keep in mind is that healthcare reform created an open enrollment period. This is a window of time each year that you can apply for health insurance, without having to experience a life event. This open enrollment period runs from November 15th through February 15th of each year. If you need coverage outside of the open enrollment period; you may still qualify to sign up. If you've had a life event such as; marriage, divorce or loss of health insurance coverage, you may be eligible to get a plan through WellPoint.

Call Our Helpline to Determine Your Eating Disorder Treatment Options

If you are experiencing problems with overeating, anorexia, bulimia or any other eating disorder, and you are ready to get help, call our helpline at 1-888-341-7785 and we'll tell you more about WellPoint insurance for eating disorder rehab(s) and other options.

Frequently Asked Questions

  • Does WellPoint Cover More than One Eating Disorder Treatment?
  • Most insurance companies limit eating disorder treatment to once per year. However, if you need treatment more than once in calendar year, have your doctor, therapist or nutritionist discuss your coverage options with your insurance company. Each calendar year, your benefits reset. If you need a second round of treatment in a different calendar year, WellPoint will cover it.

  • Does WellPoint Pay for Aftercare Treatment?
  • If it's determined between your doctor and WellPoint that you need aftercare treatment, it will be covered.

  • Could Using my Rehab Benefit Increase my Premiums?
  • Thanks to healthcare reform, health insurance companies cannot use your health history or claims to determine how much you pay for your policy. In the past, they were able to do this. Now they can only use your age, place of residence and tobacco status to determine your premium.

  • Has the Passing of Healthcare Reform Improved Eating Disorder Treatment?
  • It certainly has. Before the passing of the healthcare reform law, insurance companies weren't required to cover mental health coverage at all. If they did, they did not have to abide by minimum benefits. Now, they are required to offer mental health benefits similar to the other benefits in your policy.

Note: The information above is not a guarantee of benefits. If you have specific questions about WellPoint insurance for eating disorder treatment, call us at 1-888-366-2645.

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