Insurance: The Greatest Barrier to Recovery (Part 1)

One reason why eating disorders are so difficult to treat is because, in addition to addressing symptoms, you must first convince the patient that he or she is actually sick.

She might deny that she has any problem whatsoever with her eating habits and other behaviors. Or, even if she admits to struggling, she might insist that she is nowhere near as sick (i.e., as thin) as other patients.

So, imagine the ED patient’s confusion and distress when, after weeks or months of being convinced by trusted professionals and supporters that she needs (and deserves) help, another authority responds with her greatest anxiety: You’re not sick enough.

That is the message I have received time and time again from my insurance company.

Last December, I began treatment in a partial hospitalization program (PHP) or day program. Monday through Friday, from 8:30 a.m. until 2:00 p.m., I joined a dozen other women for two meals, meal support therapy, individual and group therapy, nutritional counseling, and psychiatric care. My insurance company covered my eight-week stay in full, leaving me with just a $10 copay—which was crucial, because I had taken a medical leave from work to seek treatment.

But I didn’t get better. Eleven years of battling anorexia had grown a powerful enemy, and five days of treatment per week couldn’t shake it. By 2:00 p.m. every day I was back in the throes of the disorder, fighting with it about whether I would complete the third meal on my own. After weeks of struggling, my treatment team recommended I undergo a month of 24/7 care in a residential facility.

I had been informed from the start of PHP that my insurance plan does not cover residential care. Luckily, my team discovered I was eligible for a benefit known as DTLA, or transitional living. This meant that my insurance company would continue paying for the costs of a day program while I would pay for my room and board. In other words, despite the fact that I was moving to a higher level of care my insurance company would not have to pay anything additional.

I agreed to go to residential. I packed my bags. My husband and I talked for days about how we would manage the separation.

And then insurance denied the request.

Joanna Kay is a writer in New York City who is recovering from an eating disorder. She is the author of The Middle Ground, a blog that deals with issues at the midpoint of recovery. This fall, she will be regularly blogging about eating disorders for Healthy Minds Canada. Visit her blog at middlegroundmusings.com and follow her on Twitter @_middle_ground and Facebook at facebook.com/middlegroundmusings.