Here's a checklist of what to do to get the most insurance reimbursement possible for treatment. Understanding all the factors that affect reimbursement is important when choosing a treatment centerincluding laws, mandates, insurance language, and how insurers and their appeals processes work. Important additional details are online at www.bulimiaguide.org. This website also lists the bulimia nervosa coverage policies of insurers that post such policies.
Insurance Benefits Checklist
- Get organized; prepare to be persistent, assertive, respectful and rational.
- Read the patient's complete health insurance policy to understand the contracted benefits.
- Get a log book to document all conversations with insurers and care providers; record names, dates, and notes about all conversations.
- Call the insurer to discuss benefits options and find out about levels-of-care criteria the patient must meet for eligibility.
- Ask insurer what authorizations are needed to access care that will be reimbursed.
- Assist the patient in obtaining a full psychological and physical assessment from qualified providers experienced in treating bulimia nervosa.
- Communicate with key caregivers to devise a treatment plan, identify the names of the key caregivers and their roles, define communication expectations for progress reports.
- Obtain letters of support for the treatment plan from caregivers that you can show to the insurer as needed.
- Present the treatment plan to the insurer.
- Enlist support from other family members or friends; find out how and when they are available to help.
- Assist the patient in entering treatment.
- Follow up about insurance once treatment begins to ensure reimbursement is occurring.
- If claims are denied for treatment, you may wish to file an appeal using the documentation you have collected, and make your argument reasonably. If an initial appeal is denied, you may wish to file at the next level. Treatments that have some clinical research evidence to support their use may be more convincing than requests for treatment for which no clinical research evidence is available. See the summary of ECRI's evidence report on efficacy of treatments for bulimia nervosa.