How to Appeal Denial of Anorexia Treatment Coverage

Insurance coverage for anorexia treatment may not be readily available for every patient. Insurers will often point out pre-existing conditions clauses in policies, as well as treatment limits, as part of their denials of coverage. You need to approach your appeal for denied coverage on multiple fronts to get the help that you need.

Difficulty: Moderate

Instructions

Things You'll Need:

• State insurance regulator contact information
• Copies of insurance documents
• Attorney

1. Attend treatment sessions while you appeal denial of insurance coverage for each session. Insurance companies and mediators that work on your behalf can take months to resolve issues. You need to maintain your program and worry about your health with the hopes of gaining reimbursement in the future.

2. Forward letters denying coverage to your doctors, nutritionists and other people involved in your treatment for anorexia. This process keeps everyone updated on your latest insurance issues and may encourage medical professionals to offer assistance without solicitation.

3. Seek transparency from your insurance company about its criteria for determining coverage in anorexia patients. The use of Body Mass Index, overall weight or a particular physical effect of anorexia on its own as a diagnosis can lead to a denial that is unwarranted.

4. Clarify the specific aspect of insurance coverage that is appropriate for your treatment when communicating with company representatives. Insurance policies may cover physical treatments without consideration of psychotherapy and other emotional aspects of anorexia. Simple misunderstandings over the amount of coverage you need for a specific treatment can be resolved in short order.

5. Discuss alternate arrangements with treatment professionals while you appeal an insurer's decision. This approach works best with home care professionals and smaller offices that have greater flexibility in billing patients.

6. Contact your state insurance regulators to determine the applicability of state laws to protect the rights of patients. These officers publish documents offering advice to health insurance holders and offer limited legal advice on how to approach the appeals process constructively.

7. Utilize an initial consultation with a local attorney when you anticipate legal proceedings against an insurance company. This consultation allows a legal expert to review your policy and provide courses of action that can help you continue treatment.

Tips & Warnings

• Maintain an updated paper trail of documents from insurance providers on why they denied coverage. You will need these documents if you engage in legal action or mediation with insurers to resolve your claim. You should organize letters and hard copies of emails by date to detect changes in tone by the provider.

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