American Family Insurance Coverage for Eating Disorders

The Affordable Care Act requires insurance companies, including American Family Insurance, to cover treatment for substance abuse and mental health disorders, just like they cover any regular medical event. In 2013, the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (also referred to as DSM-5) added eating disorders as their own diagnosis category to the manual. This manual serves as a universal tool for physicians when diagnose mental disorders. According to NEDA (National Eating Disorders Association), “Major insurance companies won’t cover treatment without a DSM diagnosis.”

What Kind of Coverage Does American Family Insurance Offer for Eating Disorder Treatment?

Depending on the treatment plan your doctor or therapist creates for you, American Family may cover some or most of the cost. This depends on how long your treatment program lasts and what it entails. If your eating disorder treatment is deemed medically necessary, American Family Insurance may cover:

• Aftercare
• Group therapy
• Nutritional education
• Outpatient treatment centers
• Residential treatment centers

Your custom treatment program may include nutrition specialists, a psychiatrist or psychologist, a doctor, and other professionals. While there are some limitations, coverage through American Family Insurance for Eating Disorder Treatment is quite comprehensive.

What Portion of My Treatment will be Covered?

The way your policy covers eating disorder treatment is determined by the way it covers other medical events. If your policy has a $1,000 medical deductible and after the deductible it covers 70 percent of eligible expenses, that’s how it will cover eating disorder treatment. American Family Insurance Coverage for Eating Disorder Rehab/Treatment is limited to 30 days, just like they limit other types of rehabilitation.

If I Need More Treatment than American Family Covers, Can I Pay for Myself to Continue Treatment?

Yes. You are always welcome to pay out of your own pocket for treatment, even if your insurance company has paid out the maximum benefit.

Residential vs. Outpatient Treatment

Outpatient treatment allows someone who is recovering from an eating disorder flexibility to enjoy family life, work and other daily activities. Because the treatment only lasts for part of the day, there’s time left over for other activities. Outpatient treatment is often recommended to people who are in the early stages of their disorder, have already undergone residential treatment, or simply need some help transitioning back into normal life. Residential treatment is sometimes used for people who are deeper into their disorder, have undergone outpatient treatment unsuccessfully, or who need 24 hour around-the-clock supervision and support. People with eating disorders who opt for residential treatment spend 24 hours a day in the facility focusing on their treatment.

Should I Use a Residential Treatment Center?

Residential treatment is effective and is often the right solution. However, this type of treatment is expensive, and it requires a serious commitment of time and effort. It’s a decision you‘ll want to make alongside your medical provider or therapist.

Will American Family Pay for Local Treatment and Out-of-State Treatment?

Many insurance companies, like American Family Insurance, offer national provider networks that allow you to receive in-network benefits for using physicians and facilities outside of your home state. In this case, you’ll receive good benefits if you receive treatment out of state, as long as you make sure the rehab treatment center is on the network list. If the treatment center you want to use is out of state, but it’s not in the preferred network, you may still be able to receive benefits for using that treatment center. The Affordable Care Act requires that insurance companies cover eating disorder treatment like any other medical event. Therefore, if your plan allows you to receive benefits for using out-of-network providers and facilities, you do have the option to use a treatment center that’s not in the American Family network. However, since there’s no agreement between the insurance company and the treatment center as to what price may be charged, you will likely end up paying charges above and beyond what your insurance company allows.

Does American Family Pay for Private of Luxury Treatment?

Much of the time treatment is carried out in a group setting. However, there are facilities that offer private treatment for eating disorders. Of course, they cost more than standard treatment facilities. American Family typically won’t pay for private treatment, unless your doctor feels like it’s medically necessary and makes their case to American Family Insurance before your treatment begins. American Family will have to approve treatment in a private facility. The same goes for luxury treatment. Luxury treatment offers more amenities, a comfortable home-like setting, and other extras that increase the total cost of treatment. It’s unlikely that American Family will coverage treatment received in a luxury facility, because a luxury environment won’t be medically necessary for a successful recovery.

What Does Executive Treatment Offer Over Standard Treatment?

Executive treatment is usually administered in a private setting. Its main purpose it to cater to executive professionals (often CEO’s), celebrities and other high profile individuals. Executive treatment provides an environment in which the person recovering can sustain their careers and business connections on a daily basis.

What Lengths of Eating Disorder Treatment Will American Family Pay For?

Coverage through American Family Insurance for Eating Disorder Rehab(s) is offered for up to 30 days, if it’s deemed medically necessary. Their health plans do not typically cover treatments that last 60, 90 or 180 days.

I Don’t Have Insurance. What are My Options?

Having a health insurance policy that covers eating disorder treatment is the best situation to be in, if you need help. However, if you don’t have coverage, you still have some good options.

• You can pay for eating disorder treatment out of your own pocket.
• Some treatment centers offer credit, if you qualify.
• You can take advantage of free, local support groups, like Overeaters Anonymous (OA).
• Find out if your city or state has any programs to help you recovery from eating disorders. If you aren’t sure what to do next, but you are ready to receive help, call our helpline now at 1-888-716-9806.

Questions and Answers