By Jessica Setnick, MS, RD, CEDRD, USA
You pay into an insurance plan, every month or every paycheck, for the sole purpose of knowing that when you or a family member is ill, your insurance company will support you by paying for your treatment. Yes, there are deductibles, co-pays, pages of fine print and exclusions, but surely we all agree that ultimately the purpose of health insurance is to pay for the cost of healthcare when needed. An insurance company should not tell you that you are insured and then, when you get sick, tell you that actually the treatment for your particular illness isn’t covered after all. That is fraud, plain and simple, and it is against the law. Yet that is exactly what happens on a daily, if not hourly, basis in the United States.
Insurance companies regularly commit fraud when they discriminate against insured individuals with eating disorders by rejecting their claims for coverage. Not individuals who are uninsured; individuals who have paid into the system, every paycheck, every month, every year for a lifetime, only to find out that their treatment or their dependent’s treatment is not going to be covered by the very same insurance company they have paid for this purpose.
Does your insurance policy cover treatment for eating disorders? I hope you never need to find out. But if you do need to use those benefits, you may be faced with a horrendous obstacle course of discrimination, discouragement and rejection. You may even be told that your illness or your child’s illness is not really an illness, or that your doctor’s recommendations are being ignored, because the insurance company has decided that you or your child doesn’t need that kind of treatment.
Every eating disorder treating professional I know, including myself, has experienced the tragedy of a person who desperately wants treatment but whose insurance company has unjustly refused to cover the cost. Some people can personally pay for services. Most cannot. So most eating disorder treating professionals have chosen, over and over, to provide care at low or no cost to patients who are present and willing but have no ability to pay for services.
We provide these services as long as we can do so, sometimes for years, while at the same time spending additional time advocating for our patients by phone, in writing, and sometimes in legal documents, but eventually there is a limit to what a professional can provide pro bono without going out of business.
No insurance company is a single unit. They are each made up of thousands of individuals, most of whom have not the slightest understanding of eating disorders or the toll they take on lives, bodies, minds and families. Individuals with eating disorders, those who love them, and those of us who provide treatment for them, have spent thousands of hours trying to find that mythical gatekeeper at the top of the chain of command who will finally understand, who will interrupt the chain of rejection and unlock the key to treatment. None of us have ever found that person. Even when a lawsuit is won on behalf of a patient (sometimes after their death), no one is willing to be responsible for the law-breaking, the fraud, the heartache or the tragedy. It’s simply “the policy,” “the coverage,” “the benefits package,” or “the system.”
Where is the person who has the power to change the system, to stand up against the discrimination and the buck-passing and say, “Our company will now cover treatment services for all individuals with eating disorders”? How about “Our company will stop forcing ill individuals, professionals and families to spend hours on the phone with a call center and instead will provide a professional with expertise in eating disorders to speed the process of approving the care to which they are entitled?”
There are so many important issues in the eating disorders field; questions that will not be answered today, tomorrow, or this year. But insurance discrimination is not one of them. This is a voluntary, willful misuse of the public trust, a fraud against the American people, and it can be corrected.
I support World Eating Disorders Action Day because I support every person with an eating disorder receiving timely, compassionate and appropriate treatment. I support World Eating Disorders Action Day, hoping that we can finally find the right person at the top of the chain of command, the person who can finally make a difference for those suffering with eating disorders of all kinds, today.
Jessica Setnick is the co-founder of The International Federation of Eating Disorder Dietitians (www.IFEDD.com) and Senior Fellow at Remuda Ranch.
International Federation of Eating Disorder Dietitians
Join Jessica in supporting World Eating Disorders Action Day. Be sure to follow along on Twitter @WorldEDDay and hashtag #WeDoAct, #WorldEDActionDay, @WorldEatingDisordersAction on Instagram and World Eating Disorders Action Day on Facebook.